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THE CANON OF MEDICINE 
OF AVICENNA 



AMS PRESS 

NEW YORK 



ReP,o,l„ce,l in- /.c-i-;i.,.ss„.Ji of the Trusts of the Unt.sh .11».*-. 

A physician and his patient. 

From an early .Persian MS. (Add. 27.261. f. 371b) 

" \ "Teat sage— a reader of ancient books, Greek, Persian, Latin, 
Arabian, and Svriac ; and skilled in medicine and astronomv, both 
with respect to their scientific principles and the rules of their 
practical applications ; he was experienced in all that bealeth 
and hurteth the bodv ; conversant with the virtues of every plant, 
dried and fresh, the baneful and the useful. He was versed in the 
wisdom of the philosophers, and had compassed the whole range 
of medical science and other branches of the knowledge-tree. 

Uth Xiglil '—Hiirton; Lane.) 



Library of Congress Cataloging in Publication Data 

Avicenna, 980-1037- 

A treatise on the Canon of medicine of Avicenna. 

Original work has title: al-Qanun fi al-tibb. 

Bibliography: p. 

1. Medicine, Arabic. I. Grmier, Oskar Cameron, tr, 

II. Title.' [DEEM: WZ290 A957q bk. 1 ^W^ 
E128.3-A9732 1973 610 73-12409 

ISBN: 0-404-11231-5 



U 7 



-d- .J i.J 



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Reprinted from the edition of 1930, London 
First AMS edition published in 1973 
Manfuactured in the United States of America 

AMS PRESS INC. 

NEW YORK, N. Y. 10003 



PREFACE 

The purpose of the present treatise is two-fold : 

(i) To furnish a translation of the First Book of the 
Canon of Medicine of Avicenna. The section on Anatomy 
has been omitted in favour of the first half of the Be viribus 
cordis. This assists in the second object of this treatise. Dis- 
tinctively large type is used for the translation. 

(2) To present a study of its mystical philosophy {tas- 
sawuf), especially showing where this and modern biological 
knowledge are reciprocally illuminative. 

The words of the late Prof. E. G. Browne may be quoted 
here : " Even if we rate the originality of Arabian medicine at 
the lowest, I venture to think that it will deserve more careful 
and systematic study." 

Furthermore, the Thomistic philosophy of human nature 
is specially discussed, and its applicability to the Medicine 
of the future is definitely enunciated. 

A grateful acknowledgment is made to the School of 
Oriental Studies, London Institution (University of London) 
for_ signal help in the acquisition of the Arabic, Persian, and 
Chinese essential to the purposes of the treatise. 

O. Cameron Gruner. 
London, Becember, 1929. 



v 



CONTENTS 

A. The Treatise 

page 

Preliminary Thesis: The Canon of Medicine in relation to 

modern thought - - - - - ",".." " * 

I. The intellectual culture contemporary with Avicenna 

(a) In the central Saracen empire, (b) In the 
western Saracen empire, (c) Among the 
Chinese. 

II. The knowledge presented by the Canon, as compared 

with that of to-day (§ 7- 1 8 ) " " " " " ,; 5 

(a) The Canon is a precis, (b) The word Canon. 
(V) The word " knowledge." (d) Mystical 
insight. 

III. The basic difference between the Canon and Modern 
Medicine (§ 19-22) -----""" 8 

IV. Special differences between the Canon and Modern 
Medicine (§ 23-37) -------- 1° 

(a) Conceptions .known to Avicenna ; not now 
recognised, (b) Conceptions known to modern 
medicine, but not to Avicenna. (c) Know- 
ledge common to Avicenna and modern 
medicine. 
V Of interest to the Scholar (§ 38) - - - - \ 

VI. Brief survey of the Intention of this treatise ($ 40-44) 19 
The doctrine of Matter and Form (§ 55-108) 39 

Death and Destiny (§ 11 1-1 1 5) ------- I 2 

The Humours (§ 116, 117) " " " ' " " " " ?, 
The basis of Anatomy in the Canon Q 1 18-127) - - - ±03 

The doctrine of the Breath (§ 136-150) ------ 12., 

Scholastic psychology (§ 155-165) - - I39.H3 

Coloured Plate representing the corporeal and psychical Faculties facing p. 143 

The Bath-house (§ 198, 199) ' : " ~ " " " " Ifc 

Expiative causes of Disease (§ 201) - - - - " ' P 

Chinese sphygmology (§ 208-224, 234, 235)- - - - ' 20 J> 

Table of Terminology relative to the Pulse (Latin, Arabic, Chinese) facing p. 289 
The doctrine of the pulse (§ 218-220, 225-230, 231-233) - 293-308 
Urinalysis, ancient versus modern (§ 238-239) - - - 349 

Dietetics (§ 195, 248-253) ------ ' 219 ' 4 \ 4 

Ornamental Plate, with special portraits - /<"»»£ P- 553 

Concluding Survey (§ 267-300) - - - - " - _ " 553 

• Plate : Rembrandt, " The Raising of Jairus' daughter ' - facing p. 567 

Appendix: I. Progress; II. Facts-Knowledge-Truth - 569 

ri HI. The Materia Medica of the Canon - - 57* 

References ----------- 573 

vi 



CONTENTS vii 

B. The Translation page 

Introductory words (1-5) - - - 22 

BOOK I 

. PART I 

Thesis I. Definition and Scope of Medicine (6-18) - 25 

Thesis II. Cosmology (19-25) - - - - - ' - 34 

Thesis III. The Temperaments (26-66) - - - - e 7 

Thesis IV. The Humours (67-113) - . . . . ?6 

Thesis V. Anatomy (114-135) - - - - - - 93 

Thesis VI. General Physiology (136-173) - - - 107 

Psychology (174-183) - - - - - - 135 

PART II 

Disorders of Health 

Thesis I. Definition of Terms (191-230) - - - - 156 

Thesis II. The Causes of Disease. Etiology (231-451) 173 
A. — Unavoidable Causes - - - - _ _ -17s 

(i) Extracorporeal. 

The influence of seasonal changes on the body - 183 
Climate : (a) Latitude, (5) Altitude, (c) Mountains, 
(d) Seas, (<?) Winds, (/) Soil, (g) Marshes 

(305-332) ■ - - - - - _ . . I9S 

(ii) Corporeal. Causes unavoidable because physio- 
logical. ------.... 2IO 

Dietetics (347-360) - - - - - _ -214 

The various kinds of drinking water (361-392) - 221 

B. — Facultative Causes of Disease - -" - - 230 

Balneology (400-414) ------- 232 

Thesis III. The Evidences of Disease. 

Semeiology (452-677) -------- 2=57 

Sphygmology (515-602) -------- 283 

Urinoscopy (603-674) -------- 323 

The Alvine Discharge (675-677) - - - - - - 353 

PART III 

The Preservation of Health (678-904^ - - - . ?e 7 
Dietetics (759-814, 855-859) - - '- - - - 394,432 

PART IV 

The Treatment of Disease (905-1085) ----- 460 

BOOKS II-V. Brief List of Contents - - - - 532 

Translation of " De Viribus Cordis " (168-173, 1086-1130) 123 K2a 

Index - °' ?„t 

5/9 





PRELIMINARY THESIS 

The Relation between the Canon of Medicine of Avicenna 

and Modern Thought 

CONSIDERATIONS are not wanting which entitle 
the Canon of Medicine of Avicenna to an esteemed 
position in modern thought. In the first place, there 
is the outstanding intellectual culture of the Saracen 
Empire during the period of history to which Avi- 
cenna belongs. Secondly, in the case of much of his 
teaching, it may be.said that the difference from ours 
is largely only that his speech is alien, and is apt to be 
misunderstood. In these days, the great complexity of the language 
with which we express our scientific thought corresponds with the 
intricacy of the instruments wherewith facts are elicited. Thirdly, 
many of the advances of modern times offer the solutions to the very 
theorems and propositions of former times. Finally, ideas are to be 
found in his work which provide suggestions for useful research in 
the future. 

§ I . The importance of idea over material achievement is not 
to be forgotten. The achievements of any age are subject to decay 
with the lapse of centuries, but the ideas which gave rise to them 
remain living through all cycles. Therefore to propose a real place 
for Avicenna in modern thought is not to propose a return, as it were, 
to old architecture, or the costumes of long ago. It is rather to 
render accessible to-day the picture which he painted, and so enable 
it to renew its still vital message. It is to play over again the music 
which he expressed, and enable perhaps one or two to rejoice in it. 
And this without obscuring the issue by discussing nationality, or 
schoolsof thought, or evolution of ideas, or technical methods. 

If it appear to some a fault that the master appears to have used 
passages from other works, and this without full acknowledgment, 
it should be remembered that after all a painter may use pigments 
which someone else has manufactured, and is allowed even to employ 
other persons (usually pupils) to execute certain portions of his 
picture. Indeed, even after his decease, it is not improper that some 
may have been entrusted with the delicate task of touching up faded 
portions of the canvas which he bequeathed. 

I B 



2 THE CANON OF MEDICINE 

The place for Avicenna in modern thought is gained when it is 
agreed that he shall be viewed as one who entered this world entrusted 
with a ■mission independently to express for that age, by means of 
those various tools which he then found in it, the wisdom which is 
unchanging and impersonal. So also there is the need to-day that 
this same wisdom should be re-expressed for this age by means of the 
new data which lie to our hands. 

I 

The Intellectual Culture Contemporary 
with Avicenna • 

§ 2. (a) Intellectual Culture in the Central Saracen Empire. 
Carra de Vaux, in his monograph " Avicenne," 13 furnishes particu- 
larly striking comments, as follows (p. 156) : — 

" The more we investigate the enormous literary output of the 
Arabian empire, and come into intimate appreciation of the master 
minds of the middle epoch and of antiquity, the more we become 
aware of their sincerity. 

" We should, we think, offer our salutations to these great 
personalities of that day, whose works and lives were equally 
encyclopaedic. ... 

" Our own times do not show more worthy figures ; we com- 
placently assume that there are no more worthy than ourselves 
because science, so greatly developed to-day, cannot be held all 
within one single head. That may be. But it is only right to admit 
that science has less unity and harmony to-day than formerly it had ; 
that it is less pure than it was under the grand peripatetic discipline. 
Our attitude towards that is neither humble nor sincere. 

" In these days we are concerned too much to have our name 
blazoned forth than to grasp a great extent of science. We are 
more anxious to uphold the profession than to have a passion for 
study ; we seek titles and reputation rather than real knowledge ; 
and in order to appear more specialistic than our ancestors we expose 
ourselves to the judgment of posterity as having smaller minds, 
and fettered souls." 

§ 3. (b) As to the state of civilization in the western Saracen 
empire, we have the very illuminating description of Ameer Ali in 
his " The Spirit of Islam " 2 (p. 392) : — 

" The Arabs covered the countries where they settled with 
networks of canals. To Spain they gave the system of irrigation by 
flood-gates, wheels and pumps. Whole tracts of land which now lie 
waste and barren were covered with olive groves, and the environs 
of Seville alone, under Moslem rule, contained several thousand oil- 
factories. They introduced the staple products, rice, sugar, cotton, 
and nearly all the fine garden and orchard fruits, together with many 
less important plants, like ginger, saffron, myrrh, etc. They opened 
up the mines of copper, sulphur, mercury, and iron. They 
established the culture of silk, the manufacture of paper and other 



THE CANON OF MEDICINE 3 

textile fabrics ; of porcelain, earthenware, iron, steel, leather. The 
tapestries of Cordova, the woollen stuffs of Myrcia, the silks of 
Granada, Almena, and Seville, the steel and gold work of Toledo, 
the paper of Salibah, were sought all over the world. The ports of 
Malaga, Carthage, Barcelona and Cadiz were vast commercial 
emporia for export and import. In the days of their prosperity, the 
Spanish Arabs maintained a merchant navy of more than a thousand 
„ r !Pf- The y had fact ories and representatives on the Danube. 
With Constantinople they maintained a great trade which ramified 
from the Black Sea, and the eastern shores of the Mediterranean, into 
the interior of Asia, and reached the ports of India and China, and 
extended along the African coast as far as Madagascar. 

In the midst of the tenth century, when Europe was about in 
the same condition that Caffraria is now, enlightened Moors, like 
Abul Cassem, were writing treatises on the principles of trade and 
commerce In order to supply an incentive to commercial enterprise, 
and to further the impulse to travel, geographical registers, gazetteers 
and itineraries were published under the authority of Government 
containing minute descriptions of the places to which they related, 
with particulars of the routes and other necessary matters. Travellers 
like Ibn Batuta visited foreign lands in quest of information, and 
wrote voluminous works on the people of those countries, on their 
fauna and flora, their mineral products, their climate and physical 
features with astonishing perspicacity and keenness of observation. 
The love of learning and arts was by no means confined to one 
sex. The culture and education of the women proceeded on parallel 
lines with that of the men, and women were as keen in the pursuit of 
literature and as devoted to science as men. They had their own 
colleges (for instance, at Cairo, established in 684 A.M. by the daughter 
of the Mameluke Sultan Malik Taher) ; they studied medicine and 
jurisprudence, lectured on rhetoric, ethics, and belles-lettres and 
participated with the stronger sex in the glories of a splendid 
civilization. The wives and daughters of magnates and sovereigns 
spent their substance m founding colleges and endowing universities 
in establishing hospitals for the sick, refuges for the homeless, the 
orphan and the widow." 

§4- .0) Cordova, the most celebrated western university of 
the Empire at the time of Avicenna.— This is well known as an 
instance of ^ the high degree of culture of the day. Ameer Ali, 2 
speaks of that wonderful kingdom of Cordova, which was the 
marvel of the middle ages, and which when all Europe was plunged 
m barbaric ignorance and strife alone held the torch of learning 
and civilization bright and shining before the western world." 
1 he greatness of the city is indicated by its population, which is given 
by Haeser 26 (1. 662) as 300,000, and by Campbell 12 (p. 57) as one 
million ; and by the library of " about 200,000 " volumes. To see 
the city to-day, traversed as it can be from wall to wall, within half 
an hour on foot, and to read of an extent of " 24 miles one way, and 
six m the other " (Ameer Ali\ p. 517) shows that the word " king- 
dom conveys a truer idea of its greatness. To read of " innumer- 



4 THE CANON OF MEDICINE 

able libraries, 3,800' mosques, 60,000 palaces and mansions, 200,000 
houses inhabited by the common people, 700 baths, 80,000 shops, 
besides hostels and serais " is to wonder how so much can have come 
to be now represented by so little.* Nevertheless the grand 
mosque" alone, which is still at any rate externally intact (and 
interiorly is still surely one of the wonders of the world despite its 
mutilation) stands sponsor for the rest ; and no doubt many ot 
the existing imposing buildings— now devoted to very different 
US e S -_stand for the palaces and mansions. As to the literary 
treasures, these have been traced at least in part from Spain to J?ez, 
as shown by Home" (p. 32, 6i), with the Roud El Qartas as his 
authority ; and he then points to years of pilfering from the library 
of the great mosque of El Karouiyan at Fez, as having scattered these 
works for ever out of ken. 

5 t A studv of the street names, and even the place names ana 
current dialect in " Moorish Spain " to-day also confirms the story 
of past greatness. But the mystical knowledge displayed in the 
dispositions of the decorative designs and their poetic inscriptions 
on the walls of the Alhambra halls, state-rooms, and private 
apartments can leave no doubt of unsurpassed artistic power, where 
every sense-impression was deliberately drawn on. Lights and 
shadows, and colours changing with the hours of the day ; musical 
effects of simultaneous diversity of disposition of flowing water 
perfumes ; courting of the prevailing breezes ; interior architectural 
form ; and furnishings, animate and manufactured— all these were 
combined for the achievement of a perfect representation of (divine, 
over and above human) Beauty. 

8 6. (d) Among the Chinese. The bearing of Chinese philoso- 
phical thought on the subject of Avicenna lies in the fact that we here 
meet with a notable example of intimacy of relation between world- 
conception and Medicine. The writings which are so carefully 
studied to-day by so many sinologists were extant at the time ot 
Avicenna, and are still held in the highest esteem by Chinese thinkers. 
The modern Chinese philosopher is supposed to say to the Westerner 
(Somerset Maugham 54 ): " What is the reason for which you deem 
yourselves our betters ? Have you excelled us in arts or letters ? 
Have our thinkers been less profound than yours ? Has our 
civilization been less elaborate, less complicated, ess refined than 
vours ? Why, when you lived in caves and clothed yourselves with 
skins, 'we were a cultured people. ..." The attitude towards 
western learning so displayed may be blamed by many bu. is 
certainly praised by those who have studied the philosophy most 
deeply. As long ago as 1876 we read conclusive evidence (by Sir 
Henry Howarth 35 ) that much of our vaunted civilization actually 
came from that ancient race. If some students discuss their 
philosophy with a certain cynicism (Forke 23 ),_ others (Bruce ^ 
Wilhelm 101 ) see into the justice of their conceptions. As Uarus 
remarks : "We need not be blind to the many errors and absurdities 

* " Every dwelling-place, even if it has been blessed ever so long, will one 
day become a prey."— (Old saying quoted by Ameer Ah, 1 p. 125.) 



THE CANON OF MEDICINE 5 

of the ancient occultism to understand and grant the truth that 
underlies its system." These words are exactly applicable to the 
Canon of Medicine of Avicenna. 

It should be added that errors and absurdities are apt to be ascribed to ancient 
authors which really arose from misunderstandings and ignorance on the part 
even of contemporary pupils. The subsequent generations perpetuated the errors 
and even m these days the attempt to represent the real meaning of ancient texts 
by translations exposes one to unexpected extraordinary pitfalls. Our idiom is 
so diverse from the technical Chinese. 



II 



The Nature of the Knowledge Presented 
by the Canon 

§ 7- (a) The Canon is a precis, and not a sum-total of Avicenna's 
knowledge. Numerous passages occur in the Canon which show 
that this is the case, that it is a series of notes or skeleton outlines of 
thought not too lengthy to be memorized by his students (5)— much 
as they would memorize the Quran. Thus : (2) " to the full extent 
necessary, and yet with apt brevity," (16) *' do not place in medicine 
what does not belong to it," (34) " having discussed the equable 
temperaments sufficiently," (80) " I purposely omit reference to 
certain other problems relative to the fluids of the body " : '* just as 
much as is necessary to enable you to practise medicine intelligently " 
Many passages also refer to others of his own works for further 
details to avoid confusing the purely medical issue of the Canon 
Ihese (philosophical) works are gradually becoming more widely 
known. J 

" Generally speaking, the saying of the saints and sages are 
terse, presenting only the germs of truth ; these are developed by 
later teachers and then expanded and added to. We must see 
to it, however, that we get at the original meaning of the saints 
and sages." (Chu Hsi 10 , p. 168.) 

™ + •" ^°° k ^^ ar ! ?? ly T° rds ' and the valu able part of words is the thought therein 
C °fSf d - .J 1 "* bought has a ce rtain bias, which cannot be conveyed in words 
yet the world values words as being the essence of books. But though the world 
values them, they are not of value ; as that sense in which the world values Them 
13 no \^ e **** "^h they. are valuable." (Chuang T Z u, Giles trans I. i 7 o? 

,-= „„ ! i To 3ay a W °I k 1S the P roduct ° f tte age in which an author lives' 

s certainly often an error, for it is to confuse the person's insight with the tools 

(the language at his command) available to express himself with. Similarly to work 

out the relation between a literary work and the religious belief of theauthoras 

ame'fanacv wRnT " tV'p ^ ^^ ISlamlC SCienCe and the Koran carries tte 
f^ e X laC y ^t* rt ; J h * Prophet says every soul when born is a faithful follower ; 
it is afterwards that he becomes unfaithful "—which is to sav that the form of re^ 

tSf £ thl 1S a SeC ?* da ^ ^plantation, whereas the spirit 6f a sincere life^can be 
traced to the original being. 

= =+» Avic «ma;s medicine, like Indian medicine, has been traced to the Greek 
system But it has been proved that the great works of Charaka and Susruta 
were available m Arabic, under the title of Kitab-Shawshura-al-Hindi from the 
seventh century (''Ayurveda," 1924, i. x ; and see also Weber, Hist ' of Indian 
Lit.).— Similarly, the view that the Chinese borrowed their philosophy of the five 
elements from the Turks has been sufficiently disposed of byFor^ fp ° 4 * 2 S 
—It is beside the purpose of this treatise to take up such questions. 



6 THE CANON OF MEDICINE 

S o The common notion that progress or stagnation in secular knowledge 
has alausaTrelat™hip with (a cert^a) religion is typically voiced - ^^ 
on " Medicine and the Church," bySir Farquhar Buzzard" 3 (1927 ■ ine comment 
to make is ''toft loosed nan propter hoc." The advances in the science of medicine 
as ki all other sciences are surely a part of the (divine) plan for mankind ; whereas 
?L col ateral abandonment of Religious fundamentals remains a human respon- 



sibilitv. 



8 10 (6) The word " Canon" (Qanun).— Equivalent words: 
code of laws ; series of principles. Tao ^ (cf. Forke 2 *). Prin- 
ciple is defined as "something antecedent, which exercises a real 
positive influence upon the consequent " = Causes (four kinds, 13)- 

Reasons. _ . 1 . u~ 

In view of this it is clear that the Canon is not properly to be 
regarded as an " encyclopaedia " of the knowledge of the time, or 
to be contrasted, for instance, with the now classical Osier. _ 

811 U) The word " knowledge." Knowledge is not simply 
an assemblage of " facts " ; nor is it to be made synonymous with 
« truth "—certainly not Absolute Truth, of which all human 
knowledge falls short (see diagram in Appendix), although one single 
word is capable of containing or implying all knowledge, as in 
mathematics a single term may be equated with an infinite number ot 
terms summed together. But even the mathematical sciences can 
only afford approximate truth (Hume, quoted by Maher 50 : p. 238). 
We may recall the words, " if he attain to all knowledge, he is far 
off still" (a Kempis 95 , ii. n). 

S 12. Facts, as S. Thomas 81 , (1. S3) explains, are what our 
intellect regards external objects as, and as we judge of them only 
in terms of our sense-organs, these objects may be different. God 
knows them as they are. Our intellect depends on our imagination, 
and that depends on our senses, and our senses only convey discrete 
fragments which we gather into one continuous impression regardless 
of intervening points." We live as it were in a network only the 
nodes of which are evident to the senses. _ 

S 1 *. (d) Mystical Insight.— There is a distinction between 
knowledge gained in the ordinary manner and that gained by 
"mystical insight" {Kashf). The writer of Gulshan-i-Raz^ (couplet 
299, p. 30) advises his readers to follow this, saying : 



And 



" Straightway lift yourself above time and space, ^ 

Quit the world and be yourself a world for yourselt. 

" The moment we are enlightened within, 
We go beyond the voidness of a world confronting us 

s y —Seng-ts'an, quoted by Susuki," p. i8> 



As this " opens up all of a sudden a world hitherto undreamed of it 
is an abrupt and discrete leaping from one plane of thought to 
another" (ib. p. 200). 



" Real science is seeing the fire directly, 
Not mere talk, inferring the fire from the smoke. 
Your scientific proofs are more offensive to the wise 
Than the urine and breath whence a physician inters. 



—(p. 306.) 



THE CANON OF MEDICINE 7 

" Man looks at the -surface of the ocean. Yet he is so small that he cannot 
even be compared to one of its drops, limited as he is in intellect and in his know- 
ledge. It is only to those who, having just touched creation, bow to God forgetting 
their limited self, that God has remained. These through whom God has spoken 
are the only beings who have been able to give any truth to the world." 33 — (Rose- 

anvrlun, ISt ed., 120.) 



§ 14. " The mind is not like a horizontal door which has to be 
made larger by force. You must clear away the obstructions arising 
from creaturely desire, and then it will be pure and clear with no 
limit to its knowledge. Heng Ch'u said : " When the Mind is 
enlarged it can enter into everything throughout the universe " 
Chu Hsi 10 (i. 182). " He who praises God knows about Him." 

This attitude towards Nature is to be claimed for Avicenna, on 
the plain evidence of his other writings, including the " Al Naj'at " 
which appropriately appears in the Arabic version of the Canon 
printed at Rome in 1593, and of the Libellus on the powers of the 
heart 4 (real authorship disputed) which Arnold of Villanova trans- 
lated into Latin (ca. 1235-13 12) — arfff is included in the Latin 
edition of the Canon, 1595. 

The acquisition of knowledge by this process demands nothing 
more than a keen observation of the life around us, and was as much 
within his reach as ours. Such knowledge is not too restricted to 
one period of history, one language, or to one or two universities. 
And if it should seem that because our civilization is so different 
his opportunities were much less, we may pause to reflect that the 
difference between our age and his is chiefly one of mechanical 
appurtenances and phraseology ; and that even to this day we need 
not travel far (e.g., the old streets of Cordova and Granada, or more 
definitely, to northern Africa) to see much the same sort of scenery 
as he wasaccustomed to, much the same sort of life as is drawn in the 
" 1001 Nights." In any case, what is human life, at bottom, but a 
matter _ of buying and selling, receiving and giving, seizing and 
relinquishing, constructing and demolishing, acquiring learning and 
losing it,_ seeking power and breaking it, bidding and forbidding, 
covenanting and comminating, giving in marriage and seeking to 
obtain in marriage, birth and death. 

§ 15. The significant phrase "seeing into one's own Nature" (Hui-neng • 
busuki," p. 203, m which most admirable work occur many passages by way of 
explanation) gives a graphic description of that which gives Avicenna his superiority 
lhe Canon is simply the medical garb in which the one Truth is expounded. It is 

for us also to perceive it in whatever idiom it might be described Western 

Eastern — Islamic, Confucian or Buddhist, e.g. 

It would then seem as if the mind were now able to float as it were round 'all 
the concepts man has ever given to the world, or round all the most familiar events 
of one s daily life, and perceive clearly that which can never be set forth in words 
We should then also quote the words (given in ib., p. 223, in reference to satori— 
enlightenment) I perceive of it that it is something, but what it is I cannot per- 
ceive. Only meseems that, could I conceive it, I should comprehend all truth." 

§ 16. Further than this, to find that some of the statements in 
the Canon are certainly erroneous, and that modern investigations 
have placed us at an infinitely greater advantage, does not invalidate 
the work as a whole. Its possibilities for suggesting thoughts of 
real value to-day are more realized the more one reads " between 
the lines," and the present treatise does not claim to exhaust them. 



8 THE CANON OF MEDICINE 

" Let not the authority of the writer offend thee whether he be 
of title or great learning, but-let the love or pure truth entice thee to 

read " (a Kempis 95 , i. 5)- 

„ t • -K+- ,-n+n eternal truths —A person may (a) glimpse them, (6) under- 

♦ H § tnL modlStely (?)TrSeSS then? fairly thoroughly. But m describing 

denied bv persons being told of them, tor because in urcu iuiu y 

capacities of the higher. 

Ill 

The Basic Difference Between " The Canon " 
and Modern Medicine 



The Canon treats of 



I. Speculative " Medicine." 
Certain fundamental principles 
(Cosmology, psychology, meta- 
physics) 

II. Practical Medicine. . 

A. Application of I to the study 
of (i) health, (ii) disease (ten- 
dency, predisposition, threshold 
stage, declared disease, (iii) ces- 
sation of life. 



Modern Medicine consists of 



B. Actual treatment of " disease " 
by (i) regimen, (ii) drugs, (iii) 
operative interference. 



A. Principles of Medicine 
Theory : The application of the 
facts of chemistry, physics, 
anatomy, biology to the sys- 
tematic description of innumer- 
able " diseases " classified as 
far as possible on the basis of 
the microbic theory. 
Symptomatology. Etiology. 
Diagnosis. 

B. Practice of Medicine.. 

(a) Laboratory work. 

(b) Therapeutics, pharmacol- 
ogy and dietetics. 

(c) Surgery. 

(d) Gynaecology and Obstetrics. 

(e) State Medicine : Hygiene 
in all its branches. 

(/) Psychological Medicine: 

Treatment of insanity. 
(g) Legal medicine,' etc. 



THE CANON OF MEDICINE 9 

Modern medicine is based on the conception of the universe as 
a conglomeration of dead matter out of which, by some unexplainable 
process, life may become evolved in forms. To Avicenna the whole 
of the universe is the manifestation of a universal principle of life, 
acting through the instrumentality of forms. Or, again, in modern 
medicine, the forms are the source of life ; to Avicenna they are the 
product of life. Space itself is an aspect of the one life (Hartmann, 
on Paracelsus, 28 a, p. 217). 

§ 19. In this way the difference between Avicenna's conception 
of " principles," and that of modern medicine is easily shown. To 
the school-boy " science " would consist of (a) " bookwork," 
(0) laboratory work, which his teachers would insist is the basis of (a). 
Similarly, the medical curriculum begins with lectures, though these 
are more and more inclined to become laboratory demonstrations ; 
and goes on to laboratory and hospital work. 

§ 20. In short, Avicenna's medicine, and all ancient medicine, is 
intimately bound up with philosophy, to wit, that of human nature — 
a philosophy which proves to be virtually identical with " modern 
scholastic philosophy," no doubt partly because the Quranic account 
of the origin of Man tallies with the Christian. 

§ 21. Modern Medicine, on the other hand, assuming the title 
and rank of a positive science, emphatically discards and excludes 
it. Hence we read : " the physiologist " (said Burdon Sanderson) 
" can pursue philosophy if he has a turn for it, but must understand 
that the moment he enters the field of philosophy he leaves his tools 
behind him " ; or " it is unfortunate that the limitations of scientific 
thought were often ignored by men of science in their writings . . . 
the result diverts those who know, but befogs the unsuspicious 
reader who will probably put the blame on his intelligence " (Ed. 
Hughes 36 ). 

" According to Positivism, science cannot be as Aristotle 
conceived it, the knowledge of things through their ultimate causes, 
since material and formal causes are unknowable, final causes (are) 
illusions, and efficient causes (are) simply invariable antecedents, 
while metaphysics under any form is illegitimate " (Sauvage, 17 , xii. 
313). Or, expressed more boldly, " philosophy " is considered to be 
the exact antithesis of the truth which modern medicine gives us, 
and is therefore inherently inadmissible to medicine. 

The ignorance which accounts for this attitude is only met by 
insisting on proper definitions of terms. The following apply here : 
Philosophy is " the science which is concerned with first causes and 
principles ; it is the profound knowledge of the universal order, and 
the duties which that order imposes on man (Mercier, Logique, 
1904; de Wulf 17 : xii. 26). Again, philosophy is the true perception 
and understanding of cause and effect. — Metaphysics is " that 
portion of philosophy which treats of the most general and funda- 
mental principles underlying all reality and all knowledge " (Maher 56 , 
p. 520). — Psychology is " the science which treats of the soul and its 
operations " — rand, therefore, clearly, must be the real foundation of 
Medicine. 



IO 



THE CANON OF MEDICINE 



8 22 It is in modern scholastic philosophy that the student 
finds ample exposure of the fallacy in positivism and its cognates 
enabling him to detect the difference between false and true, expressed 
with enough force of logic to satisfy the most meticulous This 
queen of all the sciences amply proves positivist science (including 
Medicine) to be incomplete knowledge when taken alone, ifte 
knowledge of movement or change must be supplemented by 
mathematical and metaphysical view-points. (Cf. Merciei ■» pp 
,q 36; and especially Wundt 17 : xu. et 35). Such men as Albertus 
Magnus and Roger Bacon were convinced of the necessity of linking 
the sciences with philosophy 17 (xii. 38). rMr u Pa 

When medicine has in this way become ennobled it reaches 
its highest degree of perfection, in that it penetrates to the very 
depths of reality 56 (p. 9), admitting this knowledge to need even 
then, a further complement to make it complete— namely, knowledge 
in relation to God (" Christian wisdom ")• 

" Sapientia est scientia qua considerat ^f^f^^T" E 
Sapientia causas primas omnium causarum considerat (In- Met I ;^ t s 2 . ^ 
cofnoscit causam altissimam simphciter, qua est Deus ^ci^r sapiens ampL^ter 
in miantnm ner regulas divinas omnia potest judicare et ordmare (bum. ineoi. 
TT I a £ art if) " Non acquiritur studio humano, sed est deursum scendens 
Ubid' V) "Cum homo per res creatas Deum cognoscit, magis videtur hoc 
Stinere ad scientiam ad quam pertinet formaliter, quam ad sapientiam ad quam 
?ert nef materianter et e converso cum secundum res divinas judicamus de rebus 
Create nTagis hoc ad sapientiam quam ad scientiam pertinet (,&. q. 9, a. 2, ad 3). 

As St. Thomas 81 said in his day, " they think that nothing exists 
besides visible creatures " (C.G., ii. 3, 1-P- 5)[N.B- Creatures 
are (a) animate, (*) inanimate] ; " they think that things P«>ceed not 
by the divine will but by natural necessity " (ib.). So even m those 
days time and fortune were expended on researches which sound 
philosophy would have shown to be inherently futile. 

We mav reflect for instance on the reiterated search for a location of the soul, 
which tLpToneer C anatomists prosecuted, and also on the commonly repeated 
Innouncement to successive students of anatomy that the pineal gland is now no 
lonTer^egarded as the site of the soul. There is the sub-conscious suggestion to the 
stafent that scientific research has effectively disposed of the medieval behef m 
S soul, whereas history only proves that the revolt against the precise te a chmgs 
„ f +nP Council of Trent 16 d S45-1563 necessarily came to naught. J. he ver> aenni 
• tion of 9 ' soul '■ whichlhis council laid down makes a search for its location ludicrous. 

IV 

Special Differences between the Canon and Modern 

Medicine 

A. Conceptions known to Avicenna ; not now recognized. 

823 There are four main conceptions belonging to the Canon, 
but not recognized by modern Medicine. To use S Thomas 
words 83 84 (i. 32 ; art. I ; p. 270) they can be shown to be not 
impossible " ; that is, the discoveries of modern science do not 
abrogate them. 



THE CANON OF MEDICINE i r 

These conceptions are relative to (a) the nature of the human 
being as a whole, (b) the constitution, (c) the " breath," (d) the 
" elements." Each of these is dealt with in some detail under the 
corresponding sections of the Canon, but some of the salient points 
are suitably referred to at this stage. 

§ 24. (a) The conception of the nature of the human being as a 
whole. — The varieties of views on this point which people in every 
country and race exhibit both in conversation and in literature, 
numerous though they are, are capable of classification under one of 
three headings : 

(i) The first — the Platonic view — regards the human being 
as " soul within a body," while admitting " soul " to be indefinable, 
and beyond the power of location. This view, widely supposed to be 
" Christian," is well known as " pagan " to students of folklore. 

(ii) The second — the scientific or rationalistic and modern view- 
takes the physical body as the fundamental, seeing in it the outcome 
of known or at least knowable forces. The facts of anatomy, 
physiology, etc., convey their own inevitable conclusions. This 
view makes its immediate appeal. From the first lesson the pupil 
is able to feel a grasp of some tangible knowledge, whereas the 
alternative third view entails a long study before the intricacies of 
abstract philosophy can be mastered. The difference between 
experience and •" poring over books " is only too obvious. The 
possibility of interweaving the two methods is not on the horizon. 

In its answer to " religion," this scientific view has no objection to raise to 
its votaries retaining a private belief in the Platonic view, if their temperament 
demands it. But this " pious belief " must not be allowed to vitiate procedure 
when scientific research is undertaken. 

This modern conception regards the body as an aggregate of 
" spare parts " which are " assembled " well, or ill ; can be repaired, 
or remedied. According as the assembling is good or bad, and 
according to the " fuel," so is there health, or susceptibility to 
infection by organisms. The kind of assembling is a matter partly 
heredity and partly of environment. 

The following remarks in a review on a recent article in Science — by Lillie— 
may be quoted from the Times, Oct. 24th, 1927, p. 19. They present the idea in 
technical language : — 

"Physiology finds the organism to be a nexus of physicochemical determina- 
tion ; differing only from non-living systems in its complexity. . . . Speaking of 
freewill, one argument against ' indeterminism ' is that ' the energy balance sheet 
of a man shows us there is no creation of energy within the bodv ' To assume 
will-power ' we conflict with Newton's first law.' . . . The ultraniicroscope alone 
suggests indeterminism, and even this may be only because we do not know enough 
about Browman movement, etc. Protoplasm is a ' heterogeneous system ' In 
heredity submicroscopical units determine the details of inheritance— but an event 
originating in an ultramicroscopic particle can spread to the whole cell or organism 
On this view, a human action appearing entirely spontaneous and voluntary to the 
actor and spectator would exhibit itself as- a succession of mechanically determined 
events capable of study and prediction in all its microscopic details But traced 
inwards it would ultimately resolve itself into certain ultramicroscopic events in 
the interior of the nerve-cell." But *' even the freedom of the ultramicroscopic 
particle may be no more than a subtler kind of determinism beyond the reach of 
present analysis. §64 contradicts these remarks. 

It may be noted, in passing, that the doctrine of vitalism is really only another 
form of rationalism, as will appear when the scholastic doctrine is duly investigated 



12 



THE CANON OF MEDICINE 



S25 The third view— scholastic, Thomistic— presented by 
modern scholastic philosophy, has the Aristotelian basis, its 
soundness is best appreciated by careful study prolonged until the pre- 
valent inadequate and illogical conceptions of the universe are clearly 
exposed Briefly, the view is expressed in the words : the human 
being is a material body vivified by a life-principle, the two together 
constituting the rational human soul." As S. Thomas "says : It is 
not my soul that thinks, or my body that eats, but I that do both 
fp zO. In other words, again : The body and soul form one 
complete whole-one "single being ^ (p. S3); 56 (P-.302, 306). 

It is this view which underlies the whole Canon, and is expounded 
in connection with the corresponding parts of the text.^ It is this 
vie w that makes the ancient work fal 1 in line with the most modern 
Its consequences are far-reaching. The external configuration of the 
body, including the physiognomy, is a reflection of the functional 
capacity of the internal organs and general make-up of the individual. 
The character, talents, physical form, shape of individual features 
general development, and indeed every detail of the physique, length 
of limbs, of fingers, cutaneous markings, contour of the eyes and 
ears, etc, are all part and parcel with the functional conformations 
of the viscera, and the mental characters ; a study of the -visible will 
inform of the nature of the internal conformation. (Ci. 107) 

8 26 The idea that from a study of external features and general habit one 
should deduce conclusions as to functional capacities* is generally opposed by 
academic Medicine ; as is voiced by F. v. Muller 1921, quoted by Kolle, Mitt. 
Ggeb Tied 1926 40, 371) when he says " we must steadfastly avoid drawing any 
fell-reaching conclusions about the functional behaviour of the organism from a 
studv of the external characters of the body." . 

7 While it may be urged that the external features are usually misread, it may 
also be admitted that even the customary " physical examination of a Patent 
does not vield uniform results when practised, as it neces sari yis by P™so f 
varying talent. Surely, the remedy is to exert greater care, ^e may for instance 
observl how a skilled weaver will detect the site of a flaw ^ the set-up of a 
loom by a mere glance, whereas a novice discovers it only after laborious search. 

866 § On the other hand, the biochemical tests for functional capacity of organs— 
so much the vogue, and so much exploited, and so duly impressive on patients 
and their friendf-are clearly inadequate in the light of the scholastic doctrine, 
ft is true that the attempt to force the intangible to yield to mathematical formute 
rules, and weights and measures (as, for instance, in blood-cholesterol analyses) 
is sincere enough, to judge by the time, energy and money expended so freely 
But what is to be' the verdict once it is realized that the anatomical organs are , not 
functionally discrete or amenable to distinctive specific tests ? A u ^ appreci 
ation of the intimacy of relation inherent in the conception of the human being 
ins°sted on here suffices to show the futility of those labours and studies whether 
made upon man or upon the various orders of animals taken instead. 

More than this, there is the conception that the internal organs 
belong to one another beyond the anatomical limits. The heart, to 
anatomy, is a circumscribed organ ; to Avicenna it is part of a force 
occupying the whole body. " Man's heart is both corporeal and 
incorporeal " (Chu Hsi 10 , i. p. 162). So, again, the liver is simply 
;a visible portion of a " liver " whose operation pervades the whole 

* The relation between character and physique was scientifically studied by 
the Chinese 450 B.C. (Cf. Wieger.) 



THE CANON OF MEDICINE i 3 

body.* Or, to combine modern with ancient knowledge, the physical 
heart, the arterial vessels, and the sympathetic nervous system, 
including the connections between this and the sensorium and that 
which corresponds to the " sensitive soul " in its emotional aspect, 
for instance — all this is one great composite ; and its state is also 
reflected in many subtle indications which offer themselves to the keen 
observer of the patient. 

The modern research on diseases of the brain and insanity is based on the 
assumption that the material brain is the source of all nervous activities, which 
are correlated with definite biochemical, physicochemical and even structural 
changes in brain substance. Mental disease is the outcome of similar changes. 
The Platonists would consider mental disease as apart from the " soul." The 
Thomistic view leads to much more subtle conclusions, capable of lasting influence. 

(jy) The doctrine of " the constitution." 

§ 27. The term " constitution " conveys different ideas to 
different minds. The laity regard the term as synonymous with 
" temperament " or " make-up," at least in part, and consider a 
description of a patient as having a nervous temperament, a delicate 
constitution, etc., quite adequate. With this goes the conviction 
among the lay that the medical curriculum leaves the graduate fully 
able to " understand his constitution " whereas in actual fact the 
subject is never discussed. The study of physique is quite superficial, 
and is admittedly made solely to establish a diagnosis of specific 
" diseases." Hence the term, in conversation, is actually nothing 
more than platitudes. 

To modern medicine, regarding the body as corporeal, constitu- 
tion is a matter of physique, resistance to disease, mode of reaction 
to various stimuli (including psychic stimuli). Classifications of 
varieties of constitution on this basis are afforded by various writers 
in all countries — e.g., a classification into athletic, leptosomic and 
dysplastic ; into arthritic, endocrine, lymphatic, asthenic, infantilistic, 
chlorotic, etc. (Current medical journals). 

In the Canon, Avicenna establishes " constitution " in terms of 
humours, temperaments (hot, cold, dry, moist) and " elements " 
(whose proportions are set for every individual. — 47). If we go 
further, and apply to this term the method which Rumi 37 (p. 169), the 
great Persian sage demanded of students of the Quran, we shall not 
regard a patient's constitution as understood until we have studied 
the matter much more intimately. 

" Know the words of the Koran are simple, 
But within the outward sense is an inner secret one. 
Beneath that secret meaning is a third, 
Whereat the highest wit is dumbfounded. 
The fourth meaning has been seen by none 
Save God, the Incomparable and All-sufficient. 
Thus they go on, even to seven meanings, one by one, 
According to the saying of the Prophet, without doubt." 

* Cf. Paracelsus, de viribus membrorum (Hartmann, p. 219). Moreover, 

each individual " is a member of the great organism of the world " . . . " not 
a separate being isolated from Nature." (lb. p. 51). Individual: human world : 
one leucocyte : one human being. 



I4 THE CANON OF MEDICINE 

" I know," said Tawaddud, the lady most learned, " the sublime 
Koran by heart and have read it according to the seven, the ten, 
and the fourteen modes " (438th Arabian night). _ 

Therefore to draw a lesson for our study out of these indications, 
we shall see that the aim in view is to formulate a person's constitu- 
tion out of a number of components, none of which must be omitted 
from the series . To- express the whole picture many modern aspects 
must be studied— histological, biochemical, psychological^ without 
neglecting factors (metaphysical, etc.) accepted by the ancients but 
almost forgotten to-day. For instance, the past events in the 
ancestral history of the patient must be included, and all the factors 
coming into play even from the time of quickening may not be over- 

°° The insight afforded by the true conception of the nature of the 
human being in this way leads us on to an understanding ol 
individual constitutions which should be amply satisfactory. 

(/) The doctrine of " the breath." 

8 28 This subject is discussed in the course of the text (§ 136). 
The term " breath " found in Eastern writings is taken as the exact 
equivalent of Avicenna's conception, and is understood properly 
only when the " elements " are understood (see §^73). 

Equivalent terms : life-principle ; hayat ; Sj-=- ; the breath 
of life; virtus vitalis ; spiritus ;- vitality ; Hu (in Persian mys- 
ticism*) • Ch'i M, J nafas ( also used for sou1, individuality ). 

It may be conceded that many of these words are used 
synonymously with much confusion in consequence. Thus the old 
doctrine of vitalism, supported by vitalists, is not the antithesis of, 
but strictly speaking, another form of rationalism. In Paracelsus 
we read " the first matter of the elements is nothing else than lite. . ._ . 
The soul of the elements is the life of all created things. . . . There is 
aeain a difference between the soul and the life. Fire _ if it lives 
burns But if it be in its soul, that is, in its element, it lacks all 
power of burning " (Opera ii. 264). Errors of this kind are avoided 
by a careful study of the scholastic philosophy. 

(d) The doctrine of " the elements." 

§ 29. This is fully entered into at the end of the corresponding chapter in 
the transia ^ « j*"^ universe in terms of four , or five , elements has been 
found among alf peoples. To argue in favour of the doctrine almost compels an 
attempt at harmomlation of its different forms (Aristotelian, Indian, Persian, 
ChS for S • Suppose a number of people each set out to paint one certain 
landscape^ that each is of different nationality ; that each is restricted to a certain 
limited number of pigments ; that each is a true artist. The final picture presented 
bv each wiU be striking and inspiring. But it would be out of place to begin and com- 
Sre stick with stick fnd stone with stone. If we understand, we shall learn-from 
each Th™dern futurist may excite ridicule in his attempts to depict a landscape 
jn terms rf^ychic forces, which he claims to discern, but to the mind of a student 

* Hu in Chinese, p£, is not the exact equivalent, through being used more 
for the act 'of expiration— unless there is a mystical sense attached to the term. 



THE CANON OF MEDICINE 1S 

his work would have a 'different effect. These varying forms of one conception 
are amenable to intelligent understanding. (Cf. note to 20.) 

§ 30. Carus 15 (p. 34) writes : :." An explanation of the universe which derives 
all distinctions between things, conditions, relations, etc., from differences of mixture 
must have appeared very plausible to the ancient sages . . . even to-day Western 
scientists of reputation attempt to explain the universe as a congeries of force- 
centres, acting either by attraction or repulsion in analogy to positive and negative 
electricity. On the ground of this fact the educated Chinese insist with more than 
a mere semblance of truth that the underlying idea of the Chinese world-conception 
is fully borne out and justified by the results of Western science." Elsewhere the 
intimacy, in fact unity, between this philosophy and everyday life (Forke 23 pp 
239, 269) is referred to as the justification for so often quoting Chinese thought in 
expounding Avicenna. 

B. Conceptions known to modern medicine ; but not to Avicenna. 
§ 31. Among the most important of these are : 

(a) the anatomy of the circulation of the blood, (b) the rate of 
that circulation, (c) The details found in Quain's anatomy ; the 
microscopic anatomy ; such complexities as form the theme of 
Bayliss' Physiology. These details might be expressed as those of 
" the _ mechanics of the body." (d) Interactions in the tissues: 
chemical and cellular metabolism, (e) In pathology — the microbic 
theory ; the endless and always increasing number of " diseases " 
the laboratory diagnosis of dysfunction of organs ; (albuminuria was 
of course, unknown) ; symptoms as evidences of disordered reflexes. 
if) In treatment : the use of antisera and specific anti-substances of 
organisms ; hypodermic medication ; complex drug treatment has 
passed out of vogue. Surgery. 

§ 32. Considerations which suggest that these instances of 
ignorance are not as grave as is supposed, and do not invalidate the 
standing of ancient medicine in regard to actual practice : 

Ad (a). Circulation of a kind was propounded in the case of 
the " breath," the elements, and the body-fluids, though not along 
anatomical channels. The Chinese recognized a process of " revolu- 
tion," a succession of cyclical changes, an ebb and flow. Indeed it 
is suggested in Duhalde 20 (p. 184) that the Chinese knew of the 
circulation of the blood itself some hundred years B.C. 

Wieger (p.309, on Su-Wen), discussing whether the Chinese knew of the cir- 
culation of the blood twenty centuries before Harvey or not, decides truly that 
_ their knowledge of the circulation of the blood in the human microcosm was 
intuitive, not experimental, conjectured in imitation of the circulation of the vital 
principle m the universal microcosm, in which they believed They guessed the 
fact and they never verified it. . . . During more than twenty centuries, the how 
of the guessed circulation never worried their mind. The yfn-yang circulates 
m a ring, the five agents do the same, the blood the same. That is all . . .*'* 

Ad(b). The rapidity of the changes was certainly not realized. 
The Chinese apparently believed that the circulation was completed 
only fifty times in one day (there is however room for fallacious 
translation). 

Lest there should be over-satisfaction with ourselves, it may be suggested 
that the rapidity of the movement of the lymph was not realized before about 1908, 

* But if a doctrine which is common to Taoism and esotericism (that of micro- 
cosm and macrocosm) is allowed to be valid, the words " intuitive knowledge '* 
cannot be made synonymous with " conjecture," " guess " 



l6 THE CANON OF MEDICINE 

and is perhaps notfully re^^y^n Y^^^^^^^^^ 

« ISh'leal ^cfflScrf Sieria (c£. Arch. Exp. Med 19**33) 
3S not reafed the exttence of a circulation of nerve-impulses is not yet admitted. 

Ad (V> The capillaries of the liver are referred to in 83 ; 
in the body in general in 85- True, what Avicenna calls capillaries, 
are large?Aan those -we see with the microscope. But he knew that 
the bklod passes from large trunks into the liver, traverses capil- 
laries " in the liver, and re-emerges by large trunks. 

Ad (d\ Interactions in the tissues were conceived of as- 
taking place with an ebb and a flow (which is correct) ; lymph, 
exudes into the tissue-spaces. Interactions take a considerable 
tfme (true). Digestion goes on within the blood-vessels m various 

P^W^Fermentation" was the counterpart of bacterial 
growth as we know it. The term is used ^^P^^ 1 ^ 
text r e ex 78 79). Diseases were regarded chiefly as parts oi a 
pTLssflnd there were but few processes (which ^ quite ^ 
nine processes : see § 172). Urinalysis was carried out in order to 
assess the functional state of the liver (605). Qlin prioritv 

S « Ad (f). Modern medicine claims its title to superiority 
bv its successes and judges the medicine of the past by its failures. ■ 
B'ut whaTwouid the J judgment be if this method were reverse^ 
Suppose we accepted the verdict of those among the laity— not so tew 
-who are dissatisfied with their experiences of orthodox medicine 
and have turned to the " unqualified " of one kind or another ? or 
tTot^Totecountries who prefer their native doctors st i 1 or even 
those Europeans who have experienced triumphant success from 
native doctors, after modern methods had failed ? After all the 
ancient medicine is still practised from Cairo to Calcutta and a 
medicine not very different holds sway through the Far East ihe 
Ste Sir Charles Pardy Lukis (Ind. Med. Services) is quoted as 
sayine '' Many of the empirical methods of treatment adopted by 
hakims are of the greatest value, and there is no doubt whatever 
thatTheir ancestors, ages ago, knew many things which are nowadays 
beine brought forward as new discoveries (Ayurveda, 1924, 2, 1. i> 

g Drug-t g reatment.-The complexity of P™™f™**™% 
times has -iven place to simple and short ones, and the tendency is 
to dTscard them altogether. But the reasons for the ancient method 
are given in the Canon, and Avicenna s &°™ ?!* m ^^^ 
on a careful consideration of the constitution , of ^^^^ 
as' of the patient and his idiosyncrasies. Thus, certain ingredients 
wol Kwed o r disallowed in a given ^*™^ e 
according to the nature of the particular P atlent k ™f Jf"^?? 
or absence, and the amount, of nardus, ginger, fennel-seed, anise, 

• misaddress, ■■ ^^^^^^i'^^T^^l^^ 

" modest standpoint " can surely hardly be saxd to be really G enerai 



THE CANON OF MEDICINE 17 

piper, cyperus rotundus, must be according to the season, and the 
age of the patient " 89 (p. 91). , 

§ 34. Hartmann 28 (Chinesische Heilmethoden, Munch, Med. 
Woch., 1927, June 3rd, 935) describes the accuracy of native 
diagnosis (from the pulse, §204) as "disconcerting,"* and describes 
certain forms of treatment (auto-chemotherapy, Bier treatment) as 
being practised in a manner only different in outward appearance 
from the technique which we pride ourselves as being absolutely the 
" latest." " No wonder," he says, " that the Chinese are proud of 
their art, considering how long they have known that which we have 
only recently discovered. "f 

§ 35. The cynical mind cannot be upheld which passes off the 
reputed successes during the Middle Ages as coincidences, and over- 
looks the modern crowded out-patient departments as evidences of the 
limitations of our current therapy and theory ; nor can the sceptic 
be much noticed who denies miraculous cures rather than admit 
scientific theories to be in any sense inadequate. 

§ 36. Nevertheless, it is obvious that the principles of the Canon 
could not be taught over a hospital bed or in the out-patient depart- 
ment. It is true that they cannot cater for the wholesale require- 
ments of the hospital or clinic. It should be clear to the candid that 
our modern technique does not avail for 1 00 per cent, of cases ; for 
those who do not benefit at least an experiment with other systems 
of treatment should not be denied. If the fault is laid at the feet of 
over-strenuous routine work, the more leisured may yet find an 
advantage in a system which puts the details of a person's constitution 
in all its aspects into the forefront, where there is no question of 
teaching it either to classes or even to possibly indifferent individuals. 
The words of Paracelsus may be recalled, where he says : " the 
doctor who loves his art does not undertake twenty cases but five, 
knowing that no one person can conscientiously treat more than a 
certain number. No one person could ever make the whole world 
sound." 

C. Knowledge common to Avicenna and Modern Medicine. 
§ 37. A perusal of the text of the Canon will show many 
passages which apply quite well, without explanation, in these days. 
Thus, the following may be specified : the close relation between 
emotions and physiological states (shown to be even closer than 
modern research has realized)/ — The classification of people into 
sanguine, phlegmatic, bilious, saturnine, frigid, "hot." — The 
physiology of sleep, and how posture may remedy insomnia. — 

* The same wonder at their practice is recorded in a.d. 1253, when the friar 
William of Rubuck visited their country. 

\ These words can be fully endorsed, if only from a study of the Chinese classic 
on the pulse 98 (80 volumes), discussed under the heading of " The Pulse " in the 
present treatise (§ 208). Among other ancient Chinese medical works (first seen by 
the present writer in the very extensive collection in the Library of M'Gill University, 
Montreal) reference may be made to the astonishing accuracy of representations 
of medicinal and other plants, and the almost dramatic representations of various 
diseased states in the i" tsung chin ch'un by Hung Chou — extant in Avicenna's time. 
This work was reprinted between 1904 and 1924, and an older edition is in the 
Library of the School of Oriental Studies (London Institution). 

C 



l8 THE CANON OF MEDICINE 

Choice of location for dwellings. -The choice of a good drinking- 
water.-Health resorts. Climatic influences on health and dlness 
Plethoric maladies.-Dietetics.-Hydrotherap.-^egimmal reat 
ment— The uses of counter-irritation.— Bier treatment.— i he intro 
Action of remedies into the urethra.-The use o vagina 1 tampans - 
The use of anaesthetics by the mouth (medicated wines . scopola 
i^e^ -Testing the strength of a drug by animal experiment 
(Vol. 5 j.-The treatment of iSsanity by malaria (228) -The fo lowing 
oaraeraphs are interesting among many others : 106, 115, Abb. 
P ITdoubt the great difference between the ancient and modern 
is one of outlook, which accounts for the ^^^^^^ 
which appeared interesting and even important in those days is 
passed over by modern physiology and pat hology Eadi cenW 
Ls its own interest. T%£^^^^*^ tW 
^Tu^TdL.™^, fSS all kint come to be out of date, 
but the epithets "right," "wrong" do not apply. The more 
carefully we observe modern science the more evident does it become 
that iustTts terminology and subject of conversation is different. 
Things are seen from new angles, and things only surmised at then are 

amenable to tangible description now. qi restive 

Tn fact there occur moments, even at this day, when suggestive 

thoughts migh be drawn from the Canon, to help in studying the 

Sdual, tf dious, or baffling case especially whe« the p^£» 

far distant from the laboratories and appliances of modern medicine. 

V 
Of Interest to the Scholar. 

8 38. The present translation is based on the Latin versions 
published at Venice in 1608 and i 59 5, support ed ^ a s tucly °f the 
Arabic edition printed at Rome in 1 593 and the Bulaq edition 

It is true that as E. G. Browne^ p. 34) pointed out, the Latin 
Oanun swarms with barbarous words which are not merely tran- 

S^Sn many cases ^^.^^^^^£"^3 
of Arabic originals," and that Hirschberg and Lippert regard 
the Latin as almost unintelligible though they admit he slav sh 
adherence" of the Latin to the Arabic Campbell (p. ■ £39) 
states that there was a " society of translators at To edo about 
ino AD, "whose method of translating from Arabic to Latin 
was to put the Latin equivalent over the Arabic words, dis- 
r e tard°ng P Se sense of the original." It is true that m many passages 
thf obscurity is similar to the effect which would result if one were at 
this day to render idiomatic French word ^ word ^nto a^hsh. 

It is important to point out that the Latin of Volume I is very 
different from that of Vols. III-V ; so different that th< ;tra^on 
must have been the work of different persons. While the criticisms 
Se justified with regard to these three volumes, they do not apply to 



THE CANON OF MEDICINE I9 

the first whose Latin is very close to the Arabic, and hardly to be 
improved. The difficulty really is that the Arabic itself is so con- 
densed that the meaning can only be clearly represented in English 
by the use of many more words, whether to help out the meaning 
itselt, or to make a presentable reading. 

_ It may well be said, as did E. G. Browne 6 fp. 26, 27) ■ " he who 
judges Arabian Medicine only by the Latin translation wili inevitably 
under-value it and do it a great injustice. Indeed it is difficult to 
resist the conclusion that many passages in the Latin version of the 
yanun of Avicenna were misunderstood or not understood at all bv 
the translator and consequently can never have conveyed a clear idea 
to the reader. 

T , §39- The following aids to clearness have been utilized, (a) 
The study of Avicenna's other works, and of contemporary philo- 
sophical writings, m the existing translations, (b) The study of 
various Latin terms as understood by modern scholastic philosophy 
m its exposition of the mediaeval nomenclature. (A The use of 
modern terms when there is no reasonable doubt of their referring to 
the same idea, though the literal term in the Latin is obsolete The 
careful study of the original Arabic has here been of special 
importance for words in the Latin version, which are evidently 
technical there, become merely colloquial when translated into 
English, whereas in the Arabic version, such words at once take on 
their proper character in the Arabic-English and Persian-English 
dictionaries (d) The use of tabulation of the matter. There are 
instances where this proves possible without omitting even a single 
Arabic word. (,) The use of paraphrase for certain passage 
These are marked (p). A certain freedom of rendering has been 
inevitable m view of the importance of bringing the full meaning of 
the text to the reader s notice without subjecting him to the need of 

ori|Sal A b ? *° n PaSSagC after paSSage ~ as is re quisite with the 



VI 



§ 40. The main purpose of this treatise will now be seen to 
centre m the idea that in the ancient philosophy there is material 
capable of useful application to-day. The selection of the work of 
Avicenna is not intended to provide an apologium for that one 
author, but is specially appropriate for these reasons : (i) his 
acknowledged excellence ; (ii) his greater accessibility among 
mediaeval medical writings ; (iii) a certain indefinable charm of 
expression peculiar to himself. But above all, (iv) the fact thaThis 
central theme is a conception of the nature of the human being really 
identical with that of Thomistic philosophy, and in theie days 
specially stressed and developed by « modern scholastic philosophy '' 
As these are related, so might Avicenna be related to a modern 



2Q THE CANON OF MEDICINE 

,he ° wa Mercier" " we do not regard the Thomistic philosophy 
kWar^tXm wLht^ ^her arid" (footnote, 

P ' 3 With Maher ■««"... resuscitate and " (apply to Medicine) 
« W a p^ycho'logy that has already survived four and twenty 
centuries, Ed has Ed more influence ; on human though and human 

( S 3) &££J^n*^^c1w# " — "Se 
Crudely expressed or perhaps faultily explained, ,t rs our pnvlege 

under 4 d1fferlnt°gatbs are not obliged to accord the* .garbs an ^ 

SnfldentThatX Zt S^Xurtsire^not so intangMe 
as at first appeared. 

" I deemed life was tranquillity and rest, 
I find it but a never-ending quest ; 

And I, who sat in q^d e a nd P ea ^ „ (Shamshad.-) 
Toil on a journey that shall never cease. ( 

•• Why should the Cosmos turn its wheel of worlds 
If not to search for Thee eternally ? 
Why should the tireless Sun arise each morn 

If not to look for Thee ? " *■ 

At last I found Thee hidden in my arms (Za uq.») 

Within my breast ! v. 



THE CANON OF MEDICINE 



21 



§ 43. That which is spread before us, beneath the unceasing 
surge and change of the crowded life of the thoroughfares of great 
cities, as well as beneath the panorama of Nature herself, was surely 
understood by those who insisted " there is no second Cause," and by 
Chu Hsi 11 in saying " the innumerable laws (of Nature) all proceed 
from one source" (p. 137). In this the thought is not pietistically of a 
Creator, .but of a living Reality met (passively or receptively) or 
encountered (actively or contestingly) by us all at all times. That 
Reality must be understood before we handle the problem of our 
patient with real efficacy. 

§ 44. In the intention of this work, then, there comes into 
consideration that greater Art of Medicine— not an ethical Hippo- 
cratic ideal, but something of the divine— an Art as real to Avicenna, 
philosopher, poet, musician, the worker among the great and the 
small, aware of the dramatic in Life, as it should be to us. So we 
step out of the world of the modern critic, the scholar, and the medical 
historian, indeed of modern medicine itself, into one in which we 
stand, as it were, hand in hand, with the great Master of the East— 
almost with his very eyes gazing upon and scrutinising this ever open 
book of Life of ours — divested of the false notions of " progress " and 
"time." His language is thus no longer alien— and, incidentally, 
he lives again ! 




Introductory Words 



N the first place we render thanks to Allah, for 

1 the very excellence of the order of His creation, 

and the abundance of His benefits. His 



Ih^ and tne aDunuancc ui n« — 
#\^> mercies are upon all the prophets. _ 

fc J 2. In the next place, I may say that _ it 

ifiLi is at the request of one of my very special 
friends,* one whom I feel most bound _ to 
consider, that I prepare this book on Medicine setting 
forth its general and particular laws to the full extent 
necessary, and yet with apt brevity. 

3 My plan is to deal with the general aspects of each of 
the two divisions of medicine— the speculative and the practical 
Then I shall treat of the general principles applicable to the 
diagnosis of the properties of the simples, following this with a 
detailed account of them. Then I shalHake upthe disorders 
which befall each individual member, beginning with an account 
of its anatomy, and that of its auxiliary. The anatomy of the 
several members and their auxiliaries is dealt with in the first 
book. Having completed the account of the anatomy, I shall 
show how the health of the member is to be maintained. 

4 This subject being completed, I proceed to ageneral 
discourse about general diseases -their causes, the signs by 
which they are recognized, and the modes of treatment. After 
this, I pass on to the special diseases and will point out in as 
many cases as possible-(i) the general diagnosis of their 
characters, causes and signs, (ii) the special diagnostic features, 

^^SmiSi^^ i ?A in oils han g in g in a, ante- 
haU ^J^J^W other headings *£*££■«£ —S e u d 

letters are taken from the 1608 edition in Latin, the 1523 edition of Haly Abbas, 
and various mediaeval illuminated books. 

22 



THE CANON OF MEDICINE 23 

(iii) the general rules of treatment, (iv) the special methods of 
treatment by {a) simples, (^.compounded medicines. 

I include specially designed tables under the subject of 
simples to enable you to survey the facts rapidly as to the adju- 
vants for treating disease by simples. 

Compounded medicines, and their adjuvants, and how to 
mix them I have deemed it best to consider separately in a 
" Formulary." This it is my intention to compose after the 
special subjects are dealt with. Disorders not confined to one 
member are described in this book ; the cosmetics are spoken, 
of ; and the knowledge set forth in previous books is assumed.. 
Allah helping me to complete this volume, the formulary will! 
be added to it. 

5. Every follower of my teachings who wishes to use 
them profitably should memorize most of this work, even though 
he do not quite understand it all. 

It is my intention to prepare further volumes if Allah 
should prolong my life still further, and if circumstances prove 
propitious. 

Scheme of Contents 

Book I. General^ matters relative to the science of medicine. 

1. The definition and scope of medicine. Health. 

2. The classification of diseases ; their general causes and 

symptoms. 

3. The preservation of health and regiminal treatment. 

4. The classification of the modes of treatment in general. 
Book II. Materia medica. 

Book III. Special "pathology " (Medical and Surgical). 
Book IV. Special diseases involving more than one member. 

The cosmetic art. 
Book V. Formulary. 

CONTEXTS OF BOOK I* 
Part i comprises six theses : — 

The definition of medicine. The topics of medicine. 
The imponderable elements. 
The temperaments and constitutions. 
The fluids of the body, and how they arise. 

The members (bones," muscles, nerves, arteries, veins) (= tissues and 
organs). ' v 

6. The faculties of the body: vegetative, sensitive, vital. The power of 
locomotion. The functions and operations of the body 
Part 2 comprises three theses :— y ' 

1. Ill-health : 

(a) Causes, symptoms. 

(b) States of the body ; types of disease. 

(c) Disorders of configuration. 

* The Latin text is abridged here. 



24 THE CANON OF MEDICINE 

Id) Loss of continuity. 

(e) Diseases of the composition. 

if) Disfigurements. , 

'(g) The phases or cyles of disease. 

2. The" causes of disease : 

(a) Atmospheric, seasonal, winds, localities , the sun. 
(&) Vegetative functions. 
(c) Food and drink. 

'" B gnumittion'of the causes of each of the corporeal conditions. 

3. Thi Ivfden^es of Ul-health in (a) the pulse, (6) the urine, (c) the feces. 
Part 3 comprises five theses : — ,.,,_, ,-u^ „^i 

dietetics, fatigue. 
?: llSn^p^rfafe to the various constitutions and habits of body. 

5 - ^ Arfepitome giving the regimen in special circumstances of life. 

Part 4. The treatment of disease. . 

* 4 (There are 263 chapters in all.) 



K- 




$&$&& 




In the nams of Allah, the Merciful, the Clement. 



BOOK I 

w-n K.Y h ^ eVer ht mastere ? the first book of the Qanun, to him nothing 
w 11 be hidden of the general and fundamental principles of medicine "— 
Chahar Maqala. 7 



Part I 



THESIS I 



i. The Definition of " Medicine " 




EDICINE (6) is the science by which we 
learn, (V)the various states of'the human 
body, (i) in health, (ii) when not in health, 
(b) the means by which, (i) health is likely 
to be lost, and (ii) when lost, is likely 
tobe restored to health. In other words, 
it is the art whereby health [the beauty of 
the body — long hair, clear complexion, 
fragrance and form (Chahar Maqala)] is conserved and 
the art whereby it is restored, after being lost. 

7. Although some divide " medicine " into a 
speculative (theoretical) and a practical (applied) part, you 
have assumed that it is wholly speculative " because " 
you say " it is pure science." But truly every science has 
both a speculative and a practical aspect. Philosophy 
has a speculative and a practical side. So has medicine. 
The- difference between the two need be explained only 
m the case of medicine. Thus 



25 



2 6 THE CANON OF MEDICINE 

When in regard to medicine, we say that practice proceeds 
from Theory, we do not mean that there is one division of 
meScne by which we know, and another, distinct therefrom 
"y which we act. We mean that, these two ^aspects be ong 
together-one deals with the basic principles of knowledge he 
other with the mode of operation of these principles (with n the 
body) The former is theory ; the latter is applied knowledge.. 
8 " Theory " of medicine is that which, when mastered, 
gives us a certain kind of knowledge, apart from any question 
of treatment. Thus we say that " there are three forms of fever 
and nine -nsntutions.^ ^.^ ^ ^ ^ ^ wh; 

physician carries out, but is that branch of medical knowledge 
^ch, when acquired, enables one to form an omn on upon 
which to base the proper plan of treatment. Thus it is sad 
"for inflammatory Vi, the first agents to employ are mfegt 
dants, inspissants.'and repellants ; then we temper these with 
nToUmcants ; and, finally, when the process" sutadmg 
resolvent mollificants will accomplish the rest But it the 
SeTed focus contains matter which depends for its expulsion 
on the integrity of the principal members, such treatment is 
not applicable/ Here J theory guides to an opinion, and the 
ooinion is the basis of treatment. . 

P Once the purpose of each aspect of medicine is understood 
you can become skilled in both, even though there should 
never c6me a call for you to exercise your knowledge 

10. Another thing— there is no need to assert mat 
<< there are three states of the human body-sickness heakh 
. and a state which is neither health nor disease The first two 
cover everything. Careful consideration of the subject will 
mike it clelr to the physician either that the threefold grouping 
Tunnecessary or th£ "he group which we reject is unnecessary 
The first two states really cover everything. ^aremi 
consideration will convince the physician that the third state is 
dual— on the one hand an infirmity, and on the other a habit or. 
body [some ugliness of form, for instance] or a condition 
which cannot be called strict health although the actions and 
functions of the body are normal. One must -t risk definmg 
" health " in an arbitrary fashion, and include in it a condition 
which does not belong to it (/>.). 

' However we do not propose to argue this matter out, 
because a disputation of that kind does not really further 



medicine. 



THE CANON OF MEDICINE 2 y 

, . § & J 0&nniti * s "- "5unayn ibn Ishaqal-'Ibadi (E. G. Browne', p. i 47 )_ 
defines Medicine as the science which informs us about the states of the human 
body m health, or when it debates :from health ; how to retain health ; how to 

rtJgctJ-lJ. XL. 

It is concerned with the following : — 

i. That which is integral in the nature of the human being. The seven 
a n^ + t f Wealthy human being-four being material, essential, 
and three formal. The four 'accidental" notes 
2. -That which is apart from the nature of the human bein<* 
3- Ihe preternatural or abnormal, to which belong the d?seases their 
causes and signs. ' 




and Definition of Medicine as a Profession; the 



§ 46. The Scope 
motives underlying. 

1. Medicine as an exterior Life or Career. 

(a) The pursuit of a science. Medicine may J^e taken up as a science in itself 
for the sake of science-namely, that science which treats^ of the prevention or 
cure of disease ' . This work entails the study of cognate sciences. Lovl of know- 
ledge may be the chief motive ; that is, it is an intellectual pursuit ; though othlr 
motives may be associated. muugu umw 

_ Many branches of medical science are separated off as distinct pursuits-exter- 
nal, internal state, psychological, pathological, legal, medicine, eta As a Career 
it may be orthodox that is obedient to the laws about practice, etc. ; in which case 
it is also obedient so ely to the microbic theory of disease-or unorthodox in varioul 
degrees through following different " systems," many of which are unauthorised 
and lead to some form of illegal practice. y unauthorized, 

If Medicine be regarded as concerned with the nature and constitution of man 
(as a matter of the first importance in learning how to maintain health aS I al W?JS 
the distresses of ill-health) , it is defined virtually in the same "wa" ^as A^cenna and 
conforms also to modern scholastic philosophy. In this case the practitioner 
would centre his attention on the individual, the patient himself, rather than on some 

S^^^tST and above the disease or infection ; the const= 

to jx^&g^*^ arL ^ SClentifiC aS P 6Ct iS hSre ™de subadiaty 

t -t, P I j itS P5. imar y. motive, this form of pursuit is of course the pursuit of a live- 
lihood, and medicine 1S a form of commercial life. Its success would tw, it 
measured by the bank balance. Admittedly this is seldom of M^ Tdegree called 
wealth. After a long life of hard work, such a one might grieve at his lack of s„™ 
did he not simultaneously have motive (ii). For thlse ^ords tht appl^ " "The 
only compensation which medicine offers to wealth is the spiritual pleasure of 
sacrifice that solemn sweetness which floods our being when weTee the frurt 6f our 
pain. The dependence of the soul on the Creator, brings our obligation to Him in 
dealing with those under our care. This is what makes the weary dispensarv cUrfic 
blossom with a fullness of solace surpassing all expectations" frlST^ 

(11) Pursuit primarily for humanitarian motives— the alleviation of sufferino- 
especially of physical pain ; and of various disabilities. (The actual cure S 
is often supposed to be within human scope, though an impartial iud™t 
motteT 7 m ° dlfy SUCh ^ idea ' ) Preveilt - e ^Icme is teS ^Tame 

§ 47- 2. Medicine as an interior Life. Motives in the strict sense 
am1v J a) " W ° rldl y moi jves "—pursuit as a means of satisfying a certain egoism or 
bSnesT ° n Part ° f the d0Ct ° r himS6lf ° r ° f MS relations = P-rsuit as S or 
a- ^-\ b l Asa J orm °i 'devotion to Fellow-man. Philanthropy, (i) The relief of ™ in 
disability, suffering, etc. _ (11) Socio-political motives-theWts of leSlatton^nd 
research : sanitary medicine ; state medicine. Industrial medicine OrganiTation 
of team work both for research and the << panel." The devrtion if more ?S 



28 THE CANON OF MEDICINE 

Man in the abstract, the individual not receiving personal contact, as he. does 

Under (c) 'As a form of devotion to God. .. means of studving God both 

in ^^t^S^^t^^I^tt^^ the purpose or God 

^li) The pursuit of practice («) as a penance <* ^£$^^ S£ 
cell of your heart " So, Avicenna the Sufi seemgtox J V, m perfection 

is a disciplinary (Massignon » 11. 51 5)- <£ /^ all a nd God leads each according 
» Every soul is on the way to ^^f^'^ g 7 6) . This is the practitioner's 
to the means He selects as best ^nquery p. 97 J ^^ fee tQ ac ^ e 

" unitive way." To achieve one s ^Vf* ^ ew „ ^ ^ rf ^ L ord 

tMf desire. ( C ) A means of realizat on of «ie love 01 „ being 

is the beginning of wisdom (Medicine as a r g x will> but through 

elusion under this title)-culminating, not tbroug p every organ 

divine will, in a consciousness of the H es ^ M £ oUection ma y finally become 
and tissue, so that the state ( Hal ) ot r c that expia t io n may be accom- 
actual. (d) A means of expiation It is P°^w £ ithout his being aware 

plished through the instrumentality o the > P^an^ . g released ^ 

of the fact. He may be the ^^^o™ On the P other hand, he may fulfil 
nesses arising from causes indicated m§ 19* on are t _ f n him 

a deeper intention, especially whe * °°™ s *£ J^ of eX pression,-he may become 
the devotion of God to man may become capable otp ^ ^ ^.^ of d 

the vehicle of God's intention. As the .mas iter : j ^ one Qr two 

heard from among the sea of musicians and is on y ^ab de ac y^ utterance of t ^ at 

individual in one generation. , it of med icine as an art receives a ^dual 

§ 48 . This, the highest aim of the pursuit _oi 1 pat ients, benefiting 

reward • the subtle intangible but *^^£f^Sby the spirit of divine love 

them unknowingly ; the f » c J^ /Xof absolute realities-into that 
whereby is imparted the gift of *m*gW intone realms o ^ ft of 

which underlies deeply the appearance of this ^^ | hereby t^e for whom 
ability to counsel the P^ents along ^eroad^t too^ ; ^ ^ Neither 

this counsel is intended shall P roc ^ fj^as ™ ft Yet the former may recognize 
physician nor patient may be consc ous o E this ■ &£. related to 

tbe sa^S^^S|SiS ^ "fS S-2S& ffif 
J^'^^SS^SS^^^^ - k s of the day need evoke 

n ° Sig As°Ibn e u r 'l-Farid (..,. xr8.-r.35) «-^^^S^w^b?S da^ 
power of lifting oneself *f^^^Z^^£tox above." 
task becomes transformed all br ™^? ^ u * -n^nds, and in great cities In 
§ 49. In these days, mass-production oi an m™ 5 ^ ^^ 

those days, individual craftsmanship and ^artistr^ ; m seel ^.^^ ■ all its 
days, the organization of mod ^ t1 m ^ b . f the highways, with a certain scorn 
fofffis^ted^^e^^a^d 8 ^ leisur.efy solitude, in which could be 

—^^hl^^^ma, i steppe ^^S^ 
lanes, and in our wayfaring find ourselves back .^ those^ ti hiir f ga in a glimpse 

and forgotten seer, stay quiet* ^ ^^^^"truth is abiding and 
of Something which nothing else can reveai, 



irresistible. 



THE CANON OF MEDICINE 29 




2. The Subject-Matter of Medicine 

11. To medicine pertains the (study of the) human body 
— how its health is maintained; how it loses health. To know 
fully about each of these we must ascertain the causes of both 
health and sickness. 

12. Now as health and sickness and their causes are 
sometimes evident to the senses and sometimes only perceived 
by means of the evidence afforded by the various symptoms, 
we must m medicine gain a knowledge of the symptoms of health 
and sickness. 

It is a dictum of the exact sciences that knowledge of a thing 
is attained only through a knowledge of the causes and the origins 
of the causes. — assuming there to be causes and origins. Con- 
sequently our knowledge (of health and sickness) cannot be 
complete without an understanding both of symptoms and of 
the principles of being. 

Symptoms : the word includes our modern " signs " and 
" symptoms." Principles of being: this is the topic of scholastic 
metaphysics. Only through a knowledge of causes /—compare 
the following : — 

" It is impossible to know a thing perfectly unless we know its 
operation ; since from the mode and species of its operation we 
gauge the measure and quality of its power, while the power of a 
thing shows forth its nature : because a thing has naturally an 
aptitude for work according as it actually has such and such a 
nature. 

" Now the operation of a thing is twofold, as the Philosopher 
teaches (9 Metaph., D.8, viii. 9) ; one that abides in the very worker 
and is a perfection of the worker himself, such as to sense, to under- 
stand, and to will ; and another that passes into an outward thing 
and is a perfection of the thing made, that results from it, such as to 
heat, to cut and to build." (Contra Gent. 81 , ii. 1). 

13. There are four kinds of " cause " (of health and sick- 
ness) : — 

1. The material cause — namely, the human subject in a 
state of health or disease. The immediate subject is : the 
members and the breath. The more remote is : the humours. 
The most remote is : the (imponderable) " elements." The 
humours and the elements are composites, and they are liable 



3 o THE CANON OF MEDICINE 

to vary. But though they are subject to a variation of com- 
position and change they show a certain constant unity to which 
they converge— namely, a unity of "constitution or. of form 
ThecoSItitution is in relation to the "change" ; whereas the 
" form " is related to the " composition. . . 

2." The efficient causes are such as change or maintain the 
states of the human body. Namely :— 

Extrinsic: the air and affiliated agents: 

extrinsic iocaHt . eS) countries> ha bitable regions and the like : 

comestibles, potables, and the like. 
Intrinsic : movement and its opposite— repose of body and mind ; 
including sleep and its opposite-the waking state; 
evacuation of secretions and excretions ; and its opposite 
— retention thereof : 

the changes at the different periods of lite • 
occupations ; habits and customs : 
descent (race, nationality). 
Agents affecting the human body by contact, whether contrary to 

nature or not. 

n The formal causes : the constitutions ; the composi- 
tions ; the faculties proceeding from the constitutions. 

8 <o Costaeus, the Annotator of the Canon (1608 ed.) passes 
on to speak of health as a " harmony of the composite, the formal 
cause ofthe human body." Galen also defined temperament as he 
formal cause of the human body. It is exactly here that we find the 
S between theology and rationalism, for the former defines the 
formarcause of the human being to be what is called " the rational 

S U The refutation of the statements is adequately made by S. 

Thomas 84 (lxiii), thus : — . 

" Harmony cannot move a body or govern it, as neither can a 
temperament. A harmony and a temperament also admits oi 
de?r P ees The notion of harmony rather befits qualities of the body 
than the soul ; thus health is a harmony of the humours ; strength is 
a harmony of muscles and bones ; beauty is a harmony of limb and 
colour . Harmony may mean either the composition itself or 

the principle of composition. Now the soul is not a composition, 
because then every part of the soul would have to be the composition 
nf the parts of the body. . . . " (1, p- 166). _ 

Just as the mediaeval physicians fell into the rationalistic error 
so ably and thoroughly exposed throughout the Contra Gentiles 
when they " freed " themselves from stereotyped teaching, so with 

m0de The te ph C yskS and chemical facts which were discovered in the 
nineteenth century appeared finally to controvert both the statement 
of the Canon and those of the scholastic metaphysicians ; but it is 



THE CANON OF MEDICINE 3I 

gradually becoming clear to more and more thinkers that this is not 
the case. 

4. The final causes : the actions or functions. A know- 
ledge of these presupposes a knowledge of the faculties and 
the breaths (which are the subjects of the faculties) as we shall 
show. 

14. These then, are the subjects which pertain to 
medicine. Familiarity with them gives one insight into how the 
body is maintained m a state of health, and how it becomes ill. 
A full understanding of how health is conserved, or ill-health 
removed depends on understanding the underlying causes of 
each of these states and of their "instruments." For example— 
the regimen m regard to food, drink, choice of climate, regula- 
tions regarding labour and repose, the use of medicines, operative 
interference. r 

Physicians treat of all these points under three headings, 
as will be referredto later— health, sickness, and a state inter- 
mediate between the two. But we say that the state which they 
call intermediate" is not really a mean between the other two 

/ c u i , N °7 that WC have enumerat ed these groups of causes 
(of health and sickness) we may proceed to discuss whatever 
Medicine has to say concerning (a) the elements ; (b) the con- 
stitutions ; (,) the fluids of the body ; (d) the tissues and organs 
—simple and composite ; (*) the breaths and their natural, 
sensitive and vita faculties ; (/) the functions ; (g) the states of 
the body— health, sickness, intermediate conditions ; and 
[h) their causes— food, drink, air, water, localities of residence 
exercise, repose, age, sex, occupation, customs, race, evacuation' 
retention The external accidents to which the body is exposed 
from without ; (i) the regimen in regard to food, drink 
medicines ; exercises directed to preserving health • (f) the 
treatment for each disorder. 8 W 

16. With regard to some of these things there is nothing a 
physician can do, yet he should recognize what they are, and what 
is their essential nature— whether they are really existent or not. 
tor a knowledge of some things, he depends on the doctor of 
physical science ; in the case of other things, knowledge is 
derived by inference [reasoning]. One must presuppose a 
knowledge of the accepted principles of the respective sciences 
of ongins,_in order to know whatever they are worthy of credence 
or not [criteriology] ; and one makes inferences from the other 
sciences which are logically antecedent to these. In this manner 
one passes up step by step until one reaches the very beginnings 



32 THE CANON OF MEDICINE 

of all knowledge-namely, pure philosophy ; to wit, meta- 

PhyS Hence, if a doctor undertakes the proofs of the existence 
of the" elements " and the " constitutions and their deriva- 
tive^ from medicine itself he errs, for medicine cannot make 
tnTse things dear, belonging as they do to the domain of natural 
science. 

8 a In reeard to this last sentence note: " It is not the 

Gent In 1, refe™e l) to the same, note also the following passage by 
t t?-Vk? ?T " (v io<V "motions, molar and molecular, 

of Latin and Greek, it will be found necessary . ,m the . e»j « 
rel? ion to insist upon a ^S^* HteS^ ^ 

ability." 

17. List of what the physician aims at having a clear 
notion of ; what each is, and whether the non-manifest actually 
exist or not^ ^^ ^ ^ ^ ? there ? 

In what modes are they ? What are they ? How do they arise 
2. The temperaments and constitutions. What are tney . 

^e&ftbbod, Do they exist? How many 

ate ^^ The members and the sense-organs. [The science of 

anat 7 7 ' ] The faculties. Do they exist ? How many are there ? 
• 6. The functions. [The science of physiology.] 

7 The breaths. Do they exist ? How many are there . 
Where* are they? What changes in state do ^ey undergo 
What are the causes of retardation (lagging) of the breath . 



THE CANON OF MEDICINE 33 

(Or : the changes in the affective faculties ; and the cause of 
their persistence.) , 

8. The causes. How many are there ? 

18. The physician must also know how to arrive at 
conclusions concerning (i) the causes of illnesses and the indi- 
vidual signs thereof ; (2) the method (most likely to) remove 
the disorder and so restore health. Wherever they are obscure, 
he must be able to assign to them their duration, and recognize 
their phases. 



D 



p- 




8 


R^g 


^lip 





THESIS II. THE ELEMENTS 

LEMENTS. 19. The elements are simple 
bodies. They are the primary components 
of the human being throughout all its parts, 
as well as of all other bodies in their varied and 
diverse forms. The various orders of beings 
depend for their existence on the intermixture 
of the elements. 



Elements • Equiv. : cosmic elements ; imponderable elements ; 
primordialessenc.es; first-principles; elementary principles ; grades 

of radiance. I( ^, n+t „„ » u 1lt 

It is important to note that these dements are not ^er, but 

have only a virtual existence, as explained more fully below (§ 73 - 

309) '" Formae elementorum sunt in mixto virtute, non actum motu. 83 
(76. 4. 4. m.) 

"I am in water, and earth, and fire, and air. _ ( 

These four around me, yet of these four I am not 

(Shamsi Tabriz, 68 1. 235, 5, p. im.) 

A difference must therefore be observed between them and the 
literal earth, water, air and fire. 

Each of the latter, it must be noted, contains all four elements 
imponderable elements, the correspondingly named element being 

merely preponderant (cf. § 143). 00 „ OA . 

Simple bodies.-That is, simple m the scholastic sense 
indivisible. " Simplicity is that quality in virtue of which a sub stance 
has neither constitutive nor quantitative parts (Mercier, 5 11. 523)- 

20 Natural philosophy speaks of four elements and no 
more. The physician must accept this. Two are light, and two 
are heavy. The lighter elements are Fire and Air ; the heavier 
are Earth and Water. 

Four elements and no more.-In Chinese, Buddhist and Ayur- 
veda philosophy there are five. In theosophy also a fifth, named 
"ether'' is given. The alchemists gave three. Aristotle discussed 
a fifth saying " the heaven is not of the nature of the four elements, 
but is Sf I fifth body, existing over and above these "-quoted by 
S. Thomas 84 (68. i. p. 218). These various statements are not 
actually mutually contradictory (cf. § 29). 

34 



THE CANON OF MEDICINE 35 

Light : equivalents : weak, male (because conferring or 

inceptive), positive, active. Heaven. 

Heavy : equivalents : strong, female (because recipient), 
negative, passive. Earth. 

Heaven is man, and earth woman in character ; 
. .Whatever heaven sends it, earth cherishes. 
When earth lacks heat, heaven sends heat ; 
When it lacks moisture and dew, heaven sends them." 

(Mesnavi, 57 p. 161.) 

21. The Earth. The Earth is an " element " normally 
situated at the centre of all existence (see scheme in § 54). 
In its nature it is at rest, and all others naturally tend towards it 
at however great a distance away they might be. This is because 
of its intrinsic weight. It is cold and dry in nature, and it appears 
so to our senses as long as it is not interfered with by extraneous 
agencies, and obeys its own peculiar nature. It is by means of 
the earthy element that the parts of our body are fixed and held 
together ■ into a compacted form ; by its means the outward 
form is maintained. 

" The Earth is the warp and weft of thy body." — (Mesnavi, 5 ' p. 41.) 

" Earth " is understood in respect of its principal property of 
dryness^ 4 (69, i. p. 234). 

22. The Water. The Water is a simple substance 
whose position in nature is exterior to the (sphere of the) Earth, 
and interior to (that of) the Air. This position is owing to its 
relative density. In nature it is cold an d moist. It appears so 
to our senses as long as there are no influences to counteract it. 
Its purpose in (the world of) creation lies in the fact that it 
lends itself readily to dispersion, and consequently assumes 
any shape without permanency. In the construction of things, 
then, it provides the possibility of their being moulded and spread 
out and attempered. Being moist, shapes can be readily fashioned 
(with it) and as easily lost (and resolved). Dryness, on the other 
hand, permits forms to be assumed only with difficulty, and they 
are resolved with similar difficulty. When dryness and moisture 
alternate, the former is overruled by the latter, and thus the object 
is easily susceptible of being moulded into a form ; whereas if 
the moisture were overruled by dryness, the form and features of 
the body would become firm and constant. Moisture serves to 
protect dryness from friability ; dryness prevents moisture from 
dispersing. 



36 THE CANON OF MEDICINE 

" Verily the likeness of this present life is no other than as water 
which we send down from lieaven, and wherewith the produce of 
the earth is mixed, of which men eat, and cattle also, until the earth 
hath received its vesture and is adorned. The inhabitants thereof 
imagine that they had power over the same, but our command 
cometh unto it by night or by day, and we render it mown (as reaped 
seed-produce: Woking trans.), as though yesterday it had not 
abounded with fruits." Quran, x. 24. (p. 5h Gulshan .*.) 

Again, more specific still, Quran 18. 45- shows that Water 
enters into the plants, and only as long as it is there do they hve. 
" The parable of the life of this world : like water which We send 
down from the cloud so the herbage of the earth becomes luxuriant 
on account of it " : (Woking trans.) " min assama fa khatalatabihi 
. . " mingled with— or, as one may paraphrase (cf. the sevenfold 
interpretation of the Quran) : " water is the channel of life ; and 
note that the water came from the cloud, to which it was itself drawn 
by the solar heat ! , 

" Water has especially a life-giving power, since many animals 
originated in water, and the seed of all animals is liquid. _ Also the 
life of the soul is given by the water of baptism' 84 (ib.^74, m, p. 273). 
" Augustine holds ' water ' to mean ' formless matter. . t „ 

Water may be understood here in the sense of radical moisture 
f Paracelsus), which is absolutely essential to life, " H 2 " being thus 
as it were an instrument or substrate. The plant cannot shoot out 
leaves fiowersandfruitwithout.it; so man cannot thrive without this 
radical moisture, or innate moisture. Moreover, on this view the 
moisture is conserved by a medium which has ( material humidity 
—a concept which brings us to the domain of chemistry. 

The watery nature may be called " fluid nature ; pliability ; 

So, in the Chinese conception, Forke 23 (p. 271) explains, that 
the " fluid " of water is yang, and its substance yin; the fluid ot 
earth is yang, and its " substance " yin ; whereas the fluid ot 
fire is Yin, and its " substance " Yang. Yin is here understood in 
a procreative sense, Yang in a destructive sense. 

23. The Air. Air is a simple substance, whose position 
in nature is above the sphere of Water, and beneath that of Fire. 
This is due to its relative lightness. In nature it is hot and 
moist, according to the rule which we have given. Its effect, 
and value, in (the world of) creation is to rarefy, and render 
things finer, lighter, more delicate, softer, and consequently 
better able to move to the higher spheres. 

See also under " atmospheric air " (264). 

The air-" element," entering into the " breath," is that which 
enables us to stretch and contract, and also makes possible the 
involuntary movements throughout the body. 38 



THE CANON OF MEDICINE 3? 

24. The (sphere of the) Fire. 

" Ignis est causa omnium ignitorum." — (St. T., 81 iii. 46.) 

Fire is a simple substance, which occupies a position in 
nature higher than that of the other three elements— namely 
the hollow of the sublunary world, for it reaches to the (world of 
the) heavens. All things return to it. This is because of its 
absolute lightness. In nature it is, hot andjLry. The part 
which it plays m the construction of things is that it matures, 
rarefies, refines, and intermingles with all things. Its penetra- 
tive power enables it to traverse the substance of the air • by 
this power it also subdues the sheer coldness of the two heavy 
cold elements ; by this power it brings the elementary properties 
into harmony. 

=-h„ T ^ e d } SeTe ^9 e between the " element " fire, and fire as usually understood is 
caXrides ^t^ ^ io \™^, ** " material "' fire, and^esfcanl llkl 
canthandes urtica as essential' fire. Or, as stated under "air," there is a 

"s^LntW'^^aterial 3 "^ 1106 ° f ** JUSt aS "^" iS " radical '* « 

25. The two heavy elements enter more into the con- 
struction of the members (and fluids of the body, Costaeus), and 
contribute to repose. The two light elements enter more into 
the formation of the breaths and contribute to their movement 
as well as to the movement of the members— always remember- 
ing that it is the form that is the motor (and not the breath. 
Ihe form initiates the breaths and through them moves the 
organs of the body and the limbs.) So much for the elements. 

o-^c=-" Elemen j a subtiliora predominantur in mixta, secundum virtute • sed 
grossiora secundum quantitatem."— (Sum. Theol.," 71, i, 2m ■ 91 1 cTm ) 

inteniJence^^iS/. ^ n0urisMn S flame wM <* im P^ts heat, life," sense and 

§52. " It is the form that is the motor and not the breath " 

In this sentence is contained the crux of the whole subject " Form " 
used m the scholastic sense, has a subtly specific meaning when 
applied to the human being. This meaning is gone into in the accom- 

Pa r,n g -I XpOSition ' Briefl y> the fo rm when associated with the 
solid fluid, and gaseous components (earth, water, air) of the "body" 
is called a "living human being," and it accounts for the continual 
movement of the " breaths " (life-principle) which manifests to the 
onlooker that that human being really is living. 

§ "S3- Position in nature.— If the names of the elements are taken 
as synonymous with the corresponding words describing mundane 
nature, it is evident that earth (land) is higher than " water " ; and 
that _ air is above both. The fire (solar heat) is above all But 
mystically speaking there is such a relation apart from the P-eo- 
graphical one. s 



3 8 THE CANON OF MEDICINE 

S 54. In the following ^*\<***$^ pUaT^tolema? et°c.) 
accord^ to the ^^i^^^^SJSy due to the stand- 

Lmetfmes sdentinc-by the several schools of thought. 

SCHEME OF THE POSITION OF THE™- " WORLDS " AS 
CONCEIVED BY THE ANCIENTS. 

The Vacuum. Al-Khala ; la Khala wa la Mala. » Neither vacuum nor plenum » 

Elev£ih G He B aver 'TheSmpyrean. The seventh heaven of S. Thomas,". » wholly 

luminous " (68, p. 228). . ,!.„„,.„ j+ originates the motions of the 

Ptolemy's Empvyan ninth heaven , 

'^SrS^SSS'ta « ix4.lar.tie, ol moment 
B( tS tt H ! r "S Zodiacal e =£- ^"Tol t^te^veS 
to, Mag *tot of the ted rtars ^^ „ 

above it." Raghib. quoted m Woking transit yuran us „ 84 

^ ^k\ Bht' S^^^^el. Formed from the 

Flft h' Ma^ofrel ( T^S^ver by Azrael. Formed from the 

Fourth ThSn^^rderoleTg'lsrafil. Formed from the light of 

Third Ven Q us b SlS. The world of similitudes. Formed from 

Second MeSrf 1 Sef^med from F lk r (reflection). 
! IT Moon 'Whitejthen silver. Made from Aether. 

" The heaven of the moon." Jill 62 (?-."2) 
(Here comes " the horizon between matter and spirit. ) 
Sublunary world :» The " world of growth and decay. 
Fourth Interspace (Furja'). The Human Kingdom. 

Fourth Elemental Sphere. Igneous sphere, rvre. { the 

Divided by Rabanus into an upper region, the fiery heaven, ana 
Olympian heaven. 
Third Interspace. The Animal Kingdom. 

Third Elemental Sphere. Aerial sphere. Air. heaven, and a lower, 

Divided by Rabanus into an upper region, the etnereai 
the aerial heaven. 
Second Interspace. The Vegetable Kingdom. 

Second Elemental Sphere. Aqueous sphere Wate ^ d w aided by A. and F.). 
First Interspace. The Inorganic World (chiefly E ana w . , 
It ETeme P ntal Sphere. Terrestrial sphere Earth 
Jili refers to seven limbos of the earth" (p. 124). 



THE CANON OF MEDICINE 




Explanatory Extension of Thesis II 

i. Preliminary remarks. 
sidered <££&2$* °' ^^ ^ f ° m ' <»> C °-idered statically ; (6) Cou- 

(6) Co 3 nsid^red d^icallv. imP ° nderable ^^ : < a > C ° nsidered statica % • 
4- Application of the doctrine to biochemistry, histology, etiology, etc. 

i. Preliminary Remarks 

_ §55. Thesis II is the foundation of the whole Canon, but so 
entirely has the doctrine and world-conception of Avicenna been 
superseded by modern scientific teaching that the whole of his work 
may be said to fall with it. 

The fact that for millions of intelligent people this world- 
conception (scheme of things, theory of life, Weltanschuung) is an 
intense reality m their daily lives (Forked p. 239 ) does not usually 
signify, and yet even a training in Western universities does not 
dispose them to abandon it. 

So too, the daily-recited Breviary still contains the Benedicite 
opera omnia, m which the four " elements " sing their praise, just 
as for S. Francis in his Song of the Sun they were an instruction 
for us to do likewise. 

Their immediate dependence for existence upon the continuously 
exercised will of the Creator is spoken for both by S. Thomas Aquinas, 
in the West and by the Persian Sage in the East. " Even air, water 
earth, and fire draw their sustenance from Him, both winter and 
summer (Mesnavi). As the mighty servants of God (" to us they 
seem lifeless, but to God living," Mesnavi," p. z S ) they offer Him 
praise (Quran) and service (Mesnavi). 

The modern world-conception sets out that the universe is 
composed of chemical elements grouped into compounds, aggregated 

still Sst S " S Vary "f fr ° m ^ S l ZG ° f VaSt nebula to the'smlllJ but 
still vast suns, down to the fragments of dust beneath our feet • 
whereas he modern scholastic philosophy sees in our space-time 

iTea of°"h y e a ^T ^ tl^ 1 ^' &nd all ° WS that the ^d«t 
idea of heaven beyond the blue " evidenced understanding and not 

oSficTtion ° rt ' thG d ° Ctrine Under1 ^ Avicenna if capaHe 



4 o THE CANON OF MEDICINE 

2. The Doctrine of " Matter " and " Form " 
A. Considered Statically 

8 56. Inanimate matter, in a state of rest, is ; the -outcome of 
two principles, neither of which exists apart from the other These 
are : the principle of inertia, or passivity ; the principle : of activity. 
The former receives the scholastic term primary matter con- 
veniently abridged to m. It is the " material cause of a thing. 
The second principle is termed "form," "formal cause ; con- 
veniently abridged to /. It is non-material. 

» Man is the result of the combined operation of heaven and earth, of the 
union of two principles " (Li Ki *', vn. 3- I )- 

Every object has its /, but every / is not corporeal, for while 
some/'s are intrinsically dependent on matter, others can exist apart 

romma er ^^.^ indifferent and undetermined; it will take 
an infinite number of active principles /. But as soon as a given m 
has "akfn a given/, it ceases'to be indifferent, for it has become » f 
The union of m and / results in. a concrete object— matter, _ as 
oXaSy understood/ In other words it is said that wher, ^receives 
f a physical or corporeal substance (object) appears / 1 i said _to 
^'in-to/m " m ; whe'n that has happened we have mf" substantia^ 
form," the physical substance, " in-formed matter So / is called 
the™' formal cause " of a thing. / is also called a determining 
principle." It " perfects " or completes m. So, we say, when m 
fs completed by / a physical substance appears." /is also called 
«' essential form" Correspondingly, it is said to give rise to mf 

^''/imparts' distinctive nature to m and fixes the character and 
properties and activities resulting from the union. / provides the 
" deep intrinsic reason " for mf. 

mfmf',mf",mf" . . ■ mf would represent as many diiterent 

objects,' whether living or non-living. ^w,V a 1 

8 k mf, then, stands for the following concepts : (1) physical 

substance, corporeal substance. << Corporeal "because evident ^to 

our senses. " Substance" because viewed in its state state— 

inactive stationary. Every chemical substance is a different mf. 

(2) ' ' nature " Here it is viewed in reference to its powers of activity. 

(J) " essence " • here we describe what it is, and say what distinguishes 

one mf from another, from all other mfs. In other- words it .has 

-transcendental properties "-being, essence, unity, _ distinction 

from other beings, truth, and good. Every object is a being. Every 

object is a « creature." Every object perceptible by our senses is a 

material being. (4) " Constitution.'^ Here we study mf from the 

point of view of how it came into being. _ _ 

8 <Q Every object has three causes for its existence : material, 
formal and efficient. That which brings about the union of m 
(mSeiai cause) and/ (formal cause) is called tne " efficient cause '< 
There is another cause called the " final cause "-namely the reason 
for its existence, the reason for its creation. 



THE CANON OF MEDICINE 4 i 

§ 60. As soon as mf exists, certain qualities become manifest 
to our senses, by which we are enabled to form a mental image of the 
object— over and above the "transcendental properties" just 
referred to. These qualities are called " accidents,''. In the formula, 
we represent them by the italic a. A concrete object is therefore 
represented more accurately by the symbol mf.a, the dot 
showing, that mf forms one essence. To be more exact, then, the 
different objects around us would be represented by the formula? mf a 
mf.'a', mf."a", mf.'"a"' . . . mf.»a\ 

§61. A further scholastic term is introduced if we say that 
" when mf (' potentiality ') becomes ' actuality,' it is mfa."— This is 
another way of saying that until a substance actually exists, it has no 
" accidents," or " qualities." 

§ 62. The same symbol — mf.a — stands equally for a chemical 
atom, a chemical compound — inorganic or organic — however 
complex ; for a whole mineral ; for a histological " cell " (microbe, 
protozoan, cell-colony, simple or complex), for a whole plant or 
animal, or for a human being as a whole. Any object in the universe 
—water, stone, tree, mountain, herb, sun— can be represented by 
this same symbol. Every object is a " creature " in the Thomistic 
sense. Every object is " in-formed " matter. The differences 
between them all depend on the /. 

§ 63. " Human nature " is " informed matter," bearing certain 
properties or marks, and endowed with "existence." Each organ 
m the body is "informed matter." Every tissue is "in-formed 
matter." The blood, the lymph, the urine, etc., are each of them 
"m-formed matter." Every microscopic cell of which the tissues 
are composed is merely "in-formed matter." So also is every 
chemical entity which composes the cells, and the whole person also 
is just "informed matter." 

§64. In the case of a living human being there is this complica- 
tion that each particle of matter of which he is composed is represented 
by mf.a, and the body itself, as a whole, is representable by mf.a. To 
picture the whole person more satisfactorily we should employ a capital 
letter — say M—to stand for the actual matter of the body ; and the 
human " form " would be representable by another capital letter F 
for the human " form " differs from all other forms. Hence the 
human being is symbolized by MF, rather than by mf.f or mf+f— 
both of which would be inaccurate. M=n.mf.a. When death occurs, 
MF becomes M and F ; M becomes n.mfa again— simply a collec- 
tion of chemical inanimate substances. MF stands for "a human 
soul." F is not " soul." F does not exist without M in the first 
instance, but after death it does exist without M. However, the 
great and important fact is that at the time of death Fis no more like 
F at birth ; being different, it is correct to symbolize it as F'. 

_ The object of life is not to alter one's character, but to control it so that the 
passions never come to light. It is not for us to try and " add a cubit to our stature " 
(Mt. 6, 27) but to direct our unchangeable " character " into the very highest al- 
truistic direction. The object of life is to prevent the character from determining 
the form of one s actions. See §164 i v. s 



42 THE CANON OF MEDICINE 

Many of the laws operating in the non-living substance mf.a 
also occur in MF, though every separate MF follows its own laws. 
The laws peculiar to the chemical substances of which the body is 
composed necessarily apply in MF, as well as those pertaining to 
his being a particular MF. The mere fact of MF being altogether 
more elaborate than its component n.mf.a's (which together make M) 
does not- abrogate the applications belonging to those component 

m fs a fact which is often overlooked. Rationalism, for instance, 

assumes that because the lower are still present, the higher must 
simply be a variety of them. 

" In the living conscious being, this qualitative determining factor (the germinal 
principle) takes a still higher form, its range of activity is wider, its power of 
applying directing, and disposing of the energy stored in the organism is more 
varied and more flexible, but it cannot alter the quantity of the capital funded 
in the self-moving machine. If, then, it be the quality of the forces distributed m 
the nervous system which the directive power of the soul immediately determines, 
the liberation and control of a man's physical activity by his thoughts and volitions 
need not necessarily conflict with even the most rigid fulfilment of the law of the 
constancy of the quantity of energy." (From P. Couailhac La Liberie et la con- 
servation de l'Energie, Paris, 1897, Livre iv. ; quoted -by Mfher 5 , p. 523)- 

" If an angel or a demon set a barrel rolling down a hill by even a slight push 
the action of such a spirit would involve the invasion of the system of the material 
universe by a foreign energy. But this is not the way the soul acts, according to 
the philosophy of S. Thomas and Aristotle. Here the soul is part of the living 
being a component principle capable of liberating and guiding the transformation of 
energies (it selects and stores up) in the constitution of the material organism which 
along with its compounds goes to form a single complete individual being. (Maher , 

P ' 4 A°uin not in virtue of its rationality is the forma animale but through the 
vegetative and sentient faculties. (Aristotle, quoted m » ix. 239) 

8 6s There is an important passage on " matter in the Summa TheoL- 
(O 8s Art 1 p 185-6) which brings out the distinction between the ponderable 
and the imponderable : the interested reader should really study the whole section 
of the Summa, on the " Understanding."-" Matter is twofold common and .«gn ate 
or individual ; common, such as flesh and bone ; and individual as this flesh and 
these bones. The intellect therefore abstracts the species of a natural thing from 
the individual sensible matter, but not from the common sensible matter. . . 
Mathematical species, however, can be abstracted by the intellect ^om sensible 
matter, not only from individual, but also from common matter , not ^com- 
mon intelligible matter, but only from individual matter. . For n ^ble ^natLu is 
corporeal matter as subject to sensible qualities, such as being cold ox hot hard or 
soft and the like ; while intelligible matter is substance as subject to quantity. 
Now itTs manifest' that quantity fs in substance before other sensible qualities are. 
Hence quantities, such as number, dimension and figures, w "ch are the term ma 
tions of quantity, can be considered apart from sensible quahtie ' ^^ ev £ 
abstract them from sensible matter. . . . But some things can ;be abstracted ev.n 
from common intelligible matter, such as being, unity, power act and thebke , all 
these can exist without matter, as is plain regarding immaterial things. 

B. Considered Dynamically. Change 

" The kettle is silent, though it is boiling all the while." (Mesnavi" p. 261.) 

8 66 It is natural to consider the objects of the material world 
as being in the first place stationary ; that is, in a state of static being. 
But actually they all undergo change, from the highest to the lowest 
There is movement either in the object itself, or at the instance ot 
some other -object. Hence we now consider the dynamic changes 
in mf.a., MF. 



THE CANON OF MEDICINE 43 

§67. Changes- are of two kinds — " substantial change," 
'\M£idmtjd^Qhm,g£-'' The example of the 1ormeTTs~the chemical 
change occurring in the course of chemical reactions, mf.a becomes 
mf.'a' . The example of J^dejntajLjG&ajj^is, for instance, when 
water becomes steam ; when a person or plant grows ; when a person 
becomes emaciated, or an object shrinks in size. 

§ 68-. The nature of substantial change is most important in 
regard to physiology and pathology. The first step is associated 
with a disappearance of the old/, the process called "corruption" 
by the scholastics ; in modern words, " disintegration." There 
is then a new /' — the new " form," whose appearance is called 
" generation."* 

§ 69. From the point of view of the causes at work, there are 
three steps — an external agent or m£terialj:ajise,,axeceptiye function, 
whereby the old m receives a newTT^ncfthe efficient ca use which 
brings/' into union with m. ~ ~~~ 

§ 70. In the view of modern science, of course, the properties of " water " 
for instance, appear at the moment when the H, and O meet and unite ; the ap- 
pearance of NaCl and H 3 0, again, is adequately explained simply from the union 
of NaOH and HC1 in appropriate proportions. But Thomistic science perceives 
the need of something further. The water-molecule, or complex of molecules is 
something more than the two H atoms linked to oxygen, and this something is the 
inert principle of matter m, which releases the old / and accepts the new f 1 . As 
Rahilly explains, a molecule or a complex of molecules such as an organism, presents 
not only " colligative or summational properties, but also indiscerptible specific 
qualities of the whole which cannot be distinctively predicated of or portioned out 
among the parts." " We must therefore conceive — not imagine ! — a spatially 
complex and disparate aggregate as being in some fundamental sense, one " being. "f 

§ 71. The causes of substantial change (the efficient causes) in 
inanimate " beings " are the well-known familiar extrinsic "forces 
of nature " ; but in the case of living beings, the efficient causes are 
the intrinsic ' ^faculties " which they possess. Some of the latter 
account for changes of substance, while others have to do with a 
change of position — locomotion ; and others again excite a move- 
ment in the mind. 

§ 72. In the human being, the immediate efficient cause of an 
outwardly visible act consists of the muscles and nerves ; behind that 
is the more remote efficient cause — the sensuous appetition or desire ; 
and behind that is the sensuous cognition, which is an integral 
property of MF—a passive act, itself a " faculty." Behind that, 
peculiar to the human being, is the all-important final cause. This is 
philosophically described as " the means by which perfection of life 
is reached "—whether that "perfection" be relative or absolute, 
whether the interests of the physical body are served, or the intellectual 
life, or whether the highest perfection (i.e. of soul) is the goal in view- 
where MF uses M as the " innocent creature of God," in order to 
attain true perfection. 

*" God is an Abaser and an Exalter. Without these two processes nothing 

comes into being." Mesnavi 57 , p. 300. 

•f Rahilly, appendix to " Modern Scholastic Philosophy"" 

In animalibus quae movent seipsa est magis quaedam colligatio partium 

quam perfecta continuatio (St Thomas, In VIII. Physic. 1. 7). 



44 THE CANON OF MEDICINE 

3. The Doctrine of Imponderable Elements 
A. Considered statically 
§73. (1) Relation of the imponderable elements to " matter" 
and " form."-— Bo the elements belong to " primary matter " or to 

" form " ? 

This problem was discussed in so masterly a fashion by St. 
Thomas that his words are still applicable and unsurpassable. _ His 
perfect understanding of the nature of matter is combined with a 
precision of explanation which should satisfy every student ihe 
following quotations may be made : " By the words earth and water 
(in Gen. i.Wimary matter itself is signified " and not literal water or 
earth (Augustine**, p. 194, S. T. 66,- 1). " The ancient materia 
philosophers maintained that primary matter was some corporeal 
thing in act, as fire, air, water, or some intermediate substance 
(ib. p. 192) " Corporeal matter was impressed with the sub- 
stantial form of water, and with the substantial form of earth 
(p. 231) " The power possessed by water or earth of producing all 
animals resides not in the earth and water themselves, but in the 
power originally given to the elements of producing them from 
elemental matter " (ib. 71, i, p. 251). 

In the note to 19 it is seen that the four elements cannot be 
assigned to literal matter. But they cannot be assigned to " form " 
either, as they have no being until literal matter has itself come into 
being. Hence, while the chemical elements are mf, the imponderable 
elements are neither m nor /, for they are inseparable from mf, and 
the primary qualities of a thing do not appear until it exists — that is, 
till m and /have become mf.—" The two exist because of the one, 
but hold not even to this one " (Seng-ts'an, in Susuki 91 , p. 184)— 
words used in another connection, but equally applicable. 

§74. "Humidity" says Paracelsus 83 (ii. 264) is not_ an 
element of water, or burning an element of fire. An element is not 
to be defined according to body, substance, or quality. What is 
visible to the eyes is only the subject or receptacle." . . . Fire 
which burns is not the element of fire as we see it . . . the element of 
fire can be present in green wood no less than in fire. . . . Whatever 
grows is of the element oLfilsj2ULiS_aso^ 

fixed i"s of the'7elemenLol.,,earth, Whatever jiQurisJbfi&JsJixanjJie 
element' of air, 'and whatever "consumes is from the element of water. 
GrowthJ^el a ng^Ji3„J:he^iem£rlL.Q£~fir.-e,' , (Cf. "innate heat" § 140) 
""Where that element fails, there is no increment. Except the 
element of earth supplied it there would be no end to growth. This 
fixes it; that is to say, it supplies a terminus for the element of fire. 
So, also, unless the element of air were to act, no nutrition could be 
brought about " (Cf. oxygen) " By the air alone all things are nour- 
ished. Again, nothing can be dissolved or consumed unless the 
element of water be the cause. By it all things are mortified, and 
reduced to nothing " (ib. 266). " The invisible elements need to be 
sustained, nourished and increased by some visible thing, and at 
length they perish with them." In other words, the " elements " 



THE CANON OF MEDICINE 4S 

only exist as long as there is mf. " Both are interdependent and 
related, though their activity goes on without waste or loss." 

Each invisible attracts to itself its own. Stones come forth from the 
strong spirit of the earth " (ib. li. 279). 

1lVh+ J u T C ^P as fS es '. 1 oftei i supposed to be meaningless, become intelligible in the 
light of Thomistic philosophy, though according to biographers, Paracelsus would not 
have wished to appear to subscribe to that. 

§ 75- The imponderable elements must not, however, be con- 
fused with " accidents " (a). " Primae quatuor qualitates non sunt 
habitus e ementorum " (S. T.™, 49, 4, 1). These primary qualities 
torm the link between the object and our own consciousness, for our 
knowledge of the universe is really simply a knowledge of those 
9 u ^ llt . les (^at^coH^moist^dry) with that of secondary qualities 
(subtility, thicknessTBghtness, heaviness, rarity, density, translucence 
opacity, brilliance, dullness, etc.). " Sensible matter is corporeal 
matter as subject to sensible qualities, such as being cold or hot, hard 
or soft, and the like " (ib. Si , 85, i, p. 186). 

§ 76. So all the concrete objects of this world— from the granite 
mountain to the microscopic protozoon-— are related to one another 
in virtue of the imponderables. And in virtue of the same, they are 
related to extra-mundane objects (sun, moon, stars). " The matter 
of the heavenly bodies and of the elements agree in the character of 
potentiality " (ib. 84 ,66,2,p. 199). Since matter cannot exist without 
them, the human body itself must also manifest them. 

§ 7 2: ( 2 ) The analogy between the four elements and vibration- 
rate. The._eArth,eIe^^ a sIowl vibration- 
rate, the wa^e£^dement„., K ii.l I .,.a„moj:fi.,,r.apid rate, and" the remaining 
elements with still quicker vibration rates, "the slower rates are 
coarser^" and the more rapid ones are " finer." Hence as 
Avicenna says, the earth and water are "heavy" and the others 
are light." The meaning of the imponderable elements is made 
more intelligible through the idiom of modern science. But in 
making such an analogy we must avoid the common error of equating 
things capable of being analogized with the same thing. To compare 
»c 1 »™ ent ^ " with vibrati °n-rate, is to compare them with light. 
• £ v' i_ ^f? lance >" " spirit," " breath " have all been compared 
with light ( lux "). But to pass on to indentify them in any sense 
with lux perpetua," and then with "Universal Intellect" is 
indefensible, yet even modern thought is not immune from the 
ffi y, „ Paracelsus?2 explains "element" as "spirit" (meaning 
form, no doubt), which ' ' lives and flourishes " in the visible objects 
of Nature as the soul in the body" ..." not indeed," he explains, 
that it is of precisely the same essence as a soul, but it corresponds 
with a certain degree of resemblance. There is a difference between 
the elemental and the eternal soul. . . . For^ie^rstjnatter.QLthe 
eiement§ JJL i^ 

J h£ soul of ^elements is iheJife-of alLxreatedihingi " (ii. 264) 
Averrhoes said " of all things the soul is most like light." 

The perfect reasoning in dealing with these errors, which is given 



4 6 



THE CANON OF MEDICINE 



by S Thomas in « Contra Gentiles » should be studied by all who 

are inclined to award the last word to scientific theories _ 

are ^clmea t f -. fhe doetrine .-Tte application of the 

doctrJe to til suCject-matterif Medicine is simple when th, = element 
are represented by their corresponding " tendencies. A few ot the 
relays are showl in tabular form, by way of -illustration. Thus :- 



1 














Corres- 


Name 

of 
Ele- 
ment. 


Ten- 
dency. 


Corres- 
ponding 
system. 


Excre- 
tion. 


Special 
Sense. 


Operation 

in 

body. 


Type 

of 
mind. 


ponding 

mental 

state. 


Earth 


Spread- 


Skeletal 


Faeces 


Touch 


Gives 
shape 


Mental 
torpor 


Obstinacy. 
Fear. 


Water 


ing 

Droop- 
ing 

Down- 


Muscular 


Urine 


Taste 


Nutrition 


Lympha- 
tic 


Submis- 
sive 

Affec- 
tionate. 


Fire 


ward 
Rising 


Liver. 
Blood. 


Sweat 


Smell 


Digestion 
Physical 
move- 
ments 


Optimistic 


Anger ; 
irate Vex- 
ation (and 
weeping) 


Air 


To and 
fro 


Vascular 
Cutan- 


Saliva 


Hearing 


Respira- 
tion 


Cheerful 


Humour 


Aether 


Still- 
ness 


eous 
Nervous. 
The hair 


Semen 


Vision 


Reason- 
ing 


Reflective 


Sadness 



8 7Q The correspondence between body and mind in virtue 
8 79- ine "J p F i ole beine by the " elements," is specially 
of the pervasion ot trie wnoie Demg uy mv. > r H . u 

elaborated in a particularly interesting manner, by Chu Hsi 
t 2 12 where the five elements are taken as the < ' physical counter- 
(p.2i4),wne^tnen „ (1 righte0 usness, reverence, 

$£do£ sincTrity^whS are P present in all beings, JU st as are the 

elements. 

§80 . The Buddhist exposition of Jhe humar i being as fl co-P-d ^ five 
elements-" ^^er,"' sensation ^g^ action, ^ ^ y 

£|e S SbUsS ^intn^of rSS between q body and mind is sought after, 
in all periods of history. 

ment ,^r°e U t he r ' n in SfSXtion of the creature differs in the 
degree of ts clearness and translucence. When the ether win which 
^individual is endowed is clear and translucent . . .but neither 
the indrvidual s ena crea ,urely desire is un- 

P 7i hEante overcome and got rid of, and then we have 
avoidable , but rtcan be ^™m g indlv idual is endowed 

^"and S tt*e beclouding with creaturely des.re 



THE CANON OF MEDICINE 47 

to such an extent that it cannot be shaken off, and we have the foolish 
and degenerate " (Chu Hsi 10 , i. 117). 

§ 82. (4) Associated factors. Since the primary qualities 
belong to the elements, the laws of action and " passion " apply 
Various aspects of this law are described by the terms : strength- 
weakness ; jelal-jemal (Persian) ; qada-qadr (Arabic). These 
determine the phenomena of human life, and therefore call for con- 
sideration under the dynamic aspects of the doctrine. Statically 
they are significant to the physician because they reveal themselves in 
variations of functional capacity of organs. With the dominance 
ot the several elements we may expect corresponding vigour of the 
several systems of the body— e.g. the nutritive faculty, and the liver- 
function ; renal functions, etc. The emotional make-up, character 
and even talents for art, crafts, literature, politics, etc., attitude towards 
life m general—all these are " coloured " by the dominant " element " 
The study of the patient's features, gestures, voice, posture, hands 
acquires an added meaning, as informing about the strength or 
weakness of the several systems and faculties— to a degree which is 
not so very inferior to the information afforded by the expensive 
instruments of modern clinical research. 

See also under " destiny." (§§ in- 115) 

" Strength is the manifestation of the positive ether, and weakness 
of the negative. Each of these again is either positive, and then 
good, or negative, and then < evil.' Strength when good is 
righteous straightforward, resolute, majestic, firm ; when evil harsh 
proud, soft, irresolute, and false. The Mean (the ideal) is the main- 
tenance of these principles in equilibrium." Bruce 10 , p. m. 

B. Considered Dynamically. 

" T ^ 5 Ve f eme !l ts move unceasingly, succeeding one another in predomin- 
ance, m turn, though all always exist simultaneously " (Li Ki«, vih\ I {,3). 

" The earthy sign (of the Zodiac) succours the terrestrial earth 
ihe water sign (Aquarius) sends moisture to it 
The wmdy sign sends the clouds to it, 
To draw off unwholesome exhalations' 
The fiery sign (Leo) sends forth the heat of the sun 
Like a dish heated red-hot in front and behind ' 
The heaven is busily toiling through the ages, 
Just as men labour to provide food for women' 
And the earth does the woman's work, and toils 
In bearing offspring and suckling them." 

Mesnavi" 

^ § 8 4u T ^ ™ ovement ° f the elements is mutually opposite 
(Sum. Theol." 66 ; p. i 97 ). Change is continually talcing place 
within the human being. This change is either cyclical or pro- 
gressive. The former characterizes the ordinary phenomena of 
physiology, and the latter manifest as " growth " The cyclical 
changes of physiology (in its biochemical aspect) may be described 
in terms both of the chemical elements and of the" imponderable 
elements. To do so by the pictorial title of " the dance of the ' 



4 8 THE CANON OF MEDICINE 

elements " is at once to bring up the atmosphere of the East, and the 

very scenery of Avicenna's mind. 

" All the four elements are seething in this caldron (the world), 
None is at rest, neither earth nor fire nor water nor air 
Now earth takes the form of grass on account of desxre, 
Now water becomes air, for the sake of this affinity. 

• ■■ By way of unity, water becomes fire ; 

Fire also becomes air in this expanse, by reason of love. 
Se elements wander from place to place hke a pawn, 
Sr tne sake of the king's love, not, like you for pastime. _ 

Shamsi Tabriz" (p. 330). 

The changes are the important things ;— not the things in 
themselves for matter, after all, only exists in virtue of the ceaselessly 
acWcreat ve power of God. Did He withhold the power, at tha 
fns aft the matter would cease ; it has no reality apart from His 
n entiU S would not be a case of the world being « destroyed 
St one of " ceding to be." We are apt to be deceived by matter 
and devote our thoughts to this instead of to the changes ; and 
nerhaos the " moment of nascence " (§ 91) is even more important 
San the chang'Themselves. The greatnessof the ancient « Book 
of Changes " (Yi King) is due to the recognition of this principle. 
° S8? The advantage of this simile is that it brings out not only 
movement of a certain orderly kind, but also rhythm and W; 
Ze tTouaht being of such primitive native dances m which the 
action requires only two dancers (male and female of course) who 
a e? n the presence of many spectators. Each dancer performs 
entire^ different movements, and the two never come tnto actual 
cfntact The movements are harmonized by the music which is 
~ iZ 1? as characteristic and essential as either of the performers. 

Further tt will be clear that the feelings of the dancers themselves 
do not concern the watchers ; behind their emotions there is the real 
meamnt of the dance, and whether the dancers discern that or not 
tTe observer should strive to discern it. There may _ be special 
affinities or attractions between the dancers of the minuet; but 
Stfer their pleasure, their displeasure, their steps, nor the music, 

^ Moreterthe^kill of the dancers is not always of the same 
degree Irtistic genius may produce greater pkasure in the 

1. we K,!t there is something greater even than skill. 
^Ts? The h phen rna of^hysiology and pathology may be 
view d as a serie's of changes of analogous character th e cy de o 
changes in chemical elements, tissue-cells, and other rhythmic 
phenomena being studied without neglecting the conception of the 

imP T8r ab F:otThe nt doctrine of matter and form it is clear that 
with the changes from one chemical compound. to another m Mfce 
bourse of the cyclical phenomena, there is a dropping of *e form- 
Also, the imponderable elements rearr ange an d blend in to new 
modes at the same time. As the author of Gulshan-i-Raz (lines 
250-255 and footnote) says : 



THE CANON OF MEDICINE 49 

" The elements', water, air, fire and earth, 

Have taken their station below the heavens ; 

Each serving diligently in its own appointed place, 

Before or behind which it never sets its foot. 

Though all four are contrary in their nature and position, 

Still one may see them ever united together. 

Inimical are they to each other in essence and form, 

Yet united into single bodies by fiat of necessity. 
• From them is born the three-fold kingdom of Nature." 

_ § 8.7. To present a simple example, for illustration — Glucose, 
for instance, would be described as WA 2 F±, each letter representing 
the corresponding imponderable element. When this substance 
is broken up into alcohol and C0 2 , by the dispersal of the " cohesive 
force between the three elements (e.g., by the influence of an " op- 
posite " : the yeast-ferment), two portions of WF 2 result, the " air " 
having escaped, and the " fire-water " of the aborigines being left 
behind. This may be represented pictorially thus : 




The germination of seeds may be described in similar terms 
lnus, it would be said that the„ethereal undulations from the sun 
penetrate the loosened earth round the seeds, and'byTheir successive 
shocks affect the particles of matter composing the germinal centre of 
me seed. The readjustments of atoms and compounds with oxygen 
result in the generation of vital energy. The " earth " (mineral 
substances, arid remnants of animal and vegetable matter) mingled 
with ^ water (moisture) forms the factor of " heavy elements " (20) 
I he air (its oxygen content), " fire " (solar heat), and " aether " 
(sunlight) make up the factor of " light elements." The two series 
together affect the starch in the seed, bring about its change into 
glucose whereby the seed swells until the plumule emerges, and the 
rootlets begin to penetrate the soil in search of " water " and " earth " 
while the leaves expand to take in the " air," and " aether " by the 
aid of fire. y 

§88. Expressed in another way, there has been a change of 
vibration-rate. Or we might regard the imponderable elements as 
compulsorily riding upon the chemical elements during their 
metabolic interchanges, although the fire, water, earth or air cannot 
De thought of as retaining a sort of identity throughout. It would 
De better to use another idiom : the noumenal is coterminous with 
JM.xMnome.nal. Or, comparing it with wave^ri^olTTtTr^ If ' 
tnere were two superimposed curves. When the two curves tally 
every dip of one meets a dip in the other. The imponderable dips 



5 o THE CANON OF MEDICINE 

down a* it were into the world of matter, illuminating the' 1 ocean 
of pnysicaf matter" according to the mode (in tensity o -bration^ 
in which it touches the lower curve. A each .rue o the wave the 
former returns into the metaphysical ocean, and in doing so, 
the nhvsical matter returns to (momentary) inactivity. 
^ P Th Sealing down and building up of substance, in the coupe 
of metabolism, is the same as the scholastic corrup *°^Km- 
tegration), and "generation" (reconstruction) a ^ ^concurrent 
with the changes in the imponderable elements l *J™^*™ 
nrocess is thought of in their terms, whereas to the physiologist 
Se process is worked out in terms of the ^f^2l£rT^ g 
So in Chinese philosophy, we are introduced to the alternating 
openfng and closng P operations of Nature, which are controlled by 
the "Law," as thl pivot controls the opening and closing of a 
door "(p U4). (Cf with urooj-nasool in Sufic philosophy.) 
d °° § 4 P " Hence le find that Thesis III is ™*% *^g™™ 
consideration of the imponderables, under the title of tempera- 
men "It I the action and "passion" between the opposes 
whkh results in " temperament." This conception carried through 
Hi aspects of man provides the explanation of the diversity which 

^^S-JaW^s^^I^r&re is one and the same 
princtpt whiJhllf prevailing in the attempered ^ementary par- 
ticles is equipoise of temperament, if produced in ^aUones 
excellent and delightful intervals, if apparent m the gestures is 
Sace if found in fanguage is eloquence, if produced m*e human 
limbs' is beauty (< Though their beauty charm thee Quran Sura 
•>* v s2Y if in the qualities of the soul equity. Of this pnncipie me 
Soul is enamoured and in search, whatever form it may take, whatever 
dress a"ume " (Verses 625-630 of Gulshan-i-Raz ; many other pas- 
saees in this poem are equally applicable). _ 

This therefore forms the introduction to Thesis III. 



4- 



Applications of the Doctrine 



(a) To biochemistry. 

8 00 Starting with the conception of matter so far detailed, 
bothlSciy "^dynamically, and applying the .dynamic ^aspec * 
of the imponderable elements designated as a dance * e may pro 
ceed to trace the chemical elements and compoun d th ^f the 
VwSv entering as they do in the form of solid and fluid articles 01 

tically the whole of this time they are combined but : at the actual 
moments of chemical interchange they become free or nascent 
tVip moments when f becomes / . 

8 7 may be {aid that that moment of nascence is the focus 
or the whole purpose, of the cycle of changes which occur in the 



THE CANON OF MEDICINE 51 

body — anabolic and katabolic. That one moment is the opportunity 
for vital actions to actualize. That moment finds its location in 
this or that histological unit or tissue-element, which itself is, in a 
certain real sense, itself the actualization of that moment ! . This 
moment achieved, they become bound once more and steadily 
descend the ladder of metabolism until they are found once more 
outside the body. To quote from a deep thinker of the early 
Victorian age : "Nitrogen, like a half-reclaimed gipsy from the 
wilds, is ever seeking to be free again, and, not content with its 
own freedom, is ever tempting others not of gipsy blood to escape 
from their thraldom" (Religio Chemici, 78 p. 149). 

§ 92. At this same vital moment of the cycle, there is a change 
of the pivot of function in the substances concerned. All the sub- 
stances with which the subject of metabolism deals belong to the 
£aib2a^2mEoujids_, whose structure is well known to be described 
with the terms straight chain, double-chain, ring-compounds, etc. 
With these forms of " skeleton " are associated the various "'side- 
chains " which are to the others as the limbs to the body. All the 
familiar groups of biochemistry (paraffins, primary and secondary 
alcohols, aldehydes, acids, amides, ketones, ethers,' sulphonic acids, 
albumoses, leucins, purins, diaminoacids, sugars, etc.) may be 
thought of as presenting a sort of individuality which depends more 
on the side-chains than on the skeletons, and yet the radicles of which 
these side-chains are composed owe their character more to stereo- 
chemical position or other relations than to the elements which 
belong to them. With change of formula there is no doubt a change 
of physical state (colloid, crystalloid), of electrical reaction and so 
forth. But the fact of change (Cf. § 83) is still more important, 
even than the change of personality or individuality (so to speak). 
The pivot of function changes from one element — carbon, e.g. — 
to _ another (nitrogen, sulphur, phosphorus, e.g.). The important 
thing is that •fro i m..hemg,,£aEhQn-centric,_ the physlolo.gical...pjacesses 
,.are„ ,.. nitrogen-xentric, sulpho-centric, ...phpspho-centric. Or, uni- 
centricity gives place to duo-centricity (e.g.' sulpho-ferro-centric), or 
perhaps multi-centricity (e.g. in albumen), because the function 
cannot pass on to a new pivot unless two or more other elements have 
come into special association. 

For instance, in oxy-centricity, a compound constructed on the 
straight-chain skeleton (-C-C-C-C-) may become oxycentric, because 
the new basis is -C-C-C- (formation of anhydrides, esters, etc.). 
Here the important thing is that the centre of function is -O- and 
no longer -C-. In nitro-centricity, the change is associated with the 
appearance of -C-N-C-, the centre of function being now -N-, which 
is important. In sulpho-centricity, a compound with a group 
-C-^-OsH (thio-ethers, allyls, etc.) may arise ; this is quasi-patho- 
logical for the human body, and however insignificant the -5- mav 
be to' the chemist maybe it is evident to the senses in virtue of a 
distinctive odour. Such compounds as sulphocyanides, taurocho- 
lates, indoxylsulphates, melanin, various mucins, lardaceous sub- 
stances, hair, and the horny skin have an importance of their own, 



5 2 THE CANON OF MEDICINE 

and some of them form the links between nitro-centric and sulpho- 
centric compounds. In phospho-centricity, the dominance of the 
phosphorus atom is the culmination of the purpose of the metabolic 
change. So the author of Religio Chemici (p. 1 49) said ' ' phosphorus 
is in the active condition at the centres of vital action and in the 
passive (allotropic) state at the outlying points." In the case 01 
lecithin, there are variations of centricity. Its nitrogen, phosphorus, 
or hydroxyl may be dominant according to the metabolic circum- 
stances, and the subsequent linkages and fate of each successive 
derivative is according to those circumstances. 

Other elements may come to form important pivots of function, 
under-jnore or less exceptional conditions (e.g., arsenic, silicon, etc.). 
(§93 ) It is clear then, that we can watch the metabolic processes 
fromTfiechemical side as a sort of pageant or procession. But if we 
view it as the chemist does, according to syntheses and analyses, 
oxidations and reductions, and according to the intermediateproducts 
which he discovers when he arrests that pageant, as one might stop 
a dance in order to be sure that a certain individual was present or 
not, we mav easily come to conclusions quite at variance with the 
living truth." Stop the dance, and the illusion is destroyed, i he lite 

Vi3.s crone ! 

'"■""" Theliving cell does not necessarily follow the programme of the 
laboratory. Indeed it might be doubted whether any substances as 
such ever appear except at the end. The actual process might well be 
like a shuffling of cards, whereby the order of the cards is altered 
and the order or relative position is the important thing. On the 
anabolic side there is always the face ; on the katabohc side there is 
always the back. Between the two there are always the same atomic 
personalities which remain as it were in the same room but change 
about to receive different ranks with respect to one another 

Each element may be traced through its various phases, through 
compound after compound, its behaviour being modified by the side- 
chains, and its importance alter e^ - sojhjtns^rthas <i ^^alpiJ^lsax„. 
with the otheli~aritrWie^ 

servienFlo "another 'element whi^Ja^.^j^M^ssumedj^^V^SM 
posffibnT""Eacrirtufir receives homage from its fellows ; each enjoys 
a brief reign upon the throne. 

§ 94 Such is the chemistry of life, viewed mystically, it is an 
incessant movement. Interchanges proceed continually, and not 
only in one substance at a time, but in a thousand at a time ; not one 
element only (C, H, N, O, S, P) but all of them simultaneously— 
not necessarily one ruler, but sometimes co-rulers, in the various 
substrates of action ; not all at the same rate, but at different rates 
and with different rhythms. . 

8 95 (b) In histology.— These pictures of biochemical pro- 
cesses must be linked up with what we actually see with the naked eye 
and with the microscope. Morphological changes are all mani- 
festations of the unseen or invisible biochemical cycles. JNot 
"structure first, then function." Not "function first, then struc- 
ture " The two are inseparable both in time and place. Hence, 



THE CANON OF MEDICINE 



53 



however exact his histological knowledge, the physician must hold 
clearly before him the activities which only the mind can hold and 
piece together and watch. The histological appearance shows us the 
processes arrested at a particular moment when some group is 
dominant and another " recessive." Its very appearance is artificial, 
the produce of reagents acting upon a dead " fixed " protoplasm ; 
a reaction between complex dyes and the chemical substances 
produced by the fixatives. That which appears to be the permanent 
substrate for functions, a definite scaffolding, is quite otherwise. 
In the picture given of the dance of the elements in the body, the 
" skeleton " seems a base from which side-chains arise and give 
purchase for the " dancing " element ; but as a matter of fact the 
skeleton, the side-chain, and the element are mutually necessary. 
The whole structure is altering the whole time. So with the tissue. 
The change of chemical substances entails a change from solid to 
colloid, colloid to fluid, fluid to gas or back to colloid ; and while so 
doing they becomeperceptible under the microscope as cell-substance, 
cell-fluid, cell-juice, tissue-juice ; fluids aggregate and condense into 
" cells " (colloid phase) ; cells constantly dissolve or " splay out " 
into fluid, or undergo partition from larger and larger particles into 
submicroscopic and finally into visible microscopic particles, or else 
undergo partition into " supernatant fluids " of simpler chemical 
composition. In the course of these changes solids and the like 
separate out ; and these last are usually but faultily regarded as 
products of metabolism comparable to the goods manufactured in a 
factory. The appearance of granules rather than fluid, or precipitate 
rather than solution in the tissue, depends on the kind of elements 
concerned (mineral atoms, ordinary atom-groups), and the direction 
of interchange. See § 125. 

Some examples of the steps of the cycle towards visibility : 



Fluid phase. 


Colloid phase. 
Cell-substance 


Submicroscopic 
character. 


Microscopic- 
appearance. 


Fate. 


Homogeneous 
" humour " 


Spongioplasm 


Tissue cell 
as a whole 


Excretable 
substance and 
protein deriv- 
atives. 


Abnormal 
humour." 


Atrabilious 
humour 


Less colloidal 


Coarse part- 
icles (insol- 
uble) 


Inexcretable 
without 
medicam entous 
aid. 


Tissue-fluid 


Serum-protein 


Aminoacids 


Bioplasm ; 
occasional 
crystalline 
deposit 


Urea, etc. 


Sulphur 


Colloid Sulphur 
potentially 
excretable 
phase. 


Larger parti- 
cles of Sulphur 


Cell-granules, 
cell-wall 


Sulphur 
derivatives ; 
sulphonic 
acids, etc. 



54 THE CANON OF MEDICINE 

8 06 It is not possible to prepare a fully exact correlation be- 
tween the carbon, nitrogen, . phosphorus, and sulphur series and 
structure seen under the microscope. Bro^as^x^^c^SS^ 
series is related to the„ceU-subslanc.e.; the nitrogen an3 jjtospjwrus 
sSrleT'a7e"ais^iated with the nuclearjtructure. CertanTEnds o. 
cells are associated more with some elements than with others 
Moreover one must always bear in mind that the movement is all 
through the cell, all through the whole histologic^ unit, Ine 
fulfilment of the functions of such a unit implies the simultaneous 
movement of all the elements concerned, and each cycle proceeds at a 

8 Q7 It is less easy still to present a picture of the movement in 
a whole tissue in these terms. Only here and there does some product 
emeree which is identifiable by the physiologist and biochemist. 
Endless intermediate steps and changes find their concrete expression 
in the one product which we perceive as some, detail of cell-structure 
under the microscope. We may trace various isolated substances in 
certain parts of certain cells of the body, and yet are not able to 
dogmatize about them, because in the process of hfe.m the tissue 
there is a constant flow of matter, the visible becoming invisible, 
and then again visible. That is, the visible food material taken in, 
the invisible changes and interchanges of elements and atom groups 
(the " metabolism ") and their changing pivots of function ; and the 
finally visible product of excretion. If there be a range of variation 
froi/a " normal " in the steps of this " dance » there is at least no 
doubt that ill-health comes of a change of rhythm when the toot- 
falls " are out of time, or some of the " steps " omitted 

8 q8 It is clear that if the changes in the imponderable elements 
should chance to fail to run concurrently with the breaking down and 
building-up of substance (the scholastic corruption or disintegration 
and generation or reconstruction), this would also mean a break in the 
rhvthm : the wave-motion would not be symmetrical, to use the 
S simile; and the body would be" ill ." But il : may -be 
added, in passing, that the varying dispositions exhibited by people 
are the manifestations of lack of perfect symmetry and synchronism 
perfect symmetry would show among other things as a cheertul 

1Sp0 8 S oo° n The histology of an organ is the visible sum total of 
chemical units, with the atom" groups of ponderable tots 
successively formed in the cells and tissues. These constitute the 
stage and scenery of the metaphysical " dance "-that of the im- 
ponderable elements which interweave and complete the picture of the 
living processes. But to understand the picture itself, and seeits 
meaning, brings us to questions which must be deferred at this point. 

§ ioo. The wonderful insight into the processes taking place in Jae human 
body which is afforded by the conception of macrocosm ^ ™" t 
used by the alchemists of old, and still rightly used by many thinkers, is sufficient 
justification^ ^ .^ & ^^ of ^ beingS; composed of hundreds 

of units which have aggregated for a relatively few moments^ We , may ^cal it 
simply " a crowd," or we may specify and say what kind of a crowd. As one watches 



THE CANON OF MEDICINE 55 

it, people come up to it ; . others leave ; others walk by without deviating their 
steps. Perhaps in five minutes.it has all dispersed. 

What of it ? What was its purpose ? What was its effect ?— here or perhaps 
elsewhere ? Perhaps it is subversive of order, anarchical, pathological ■ perhaps 
it is simply mechanical, obstructive, congestive. 

Such may be observed under the microscope, but we call the components 
cells or perhaps excretory products or foreign bodies. To some, such analogising 
is fanciful and useless. But that Avicenna found this method of enquiry vastlv 
productive and helpful there is no doubt. As a faithful Moslem, too, he would 
realize the voice of the Quran, saying, " these things are to you for a sign." Words 
belonging not only to the moral law, but also to the law of Nature in all its ramifica- 
tions — for the Artificer and the Lawgiver are one. 

§ i oi. By the time we have grasped these several aspects and 
associated them with the chemical aspect of life, we have formed a 
nearer approximation to the true picture of life at that moment of 
time. But it has already passed on to something different ! How- 
ever, there is no way of keeping pace with that except by under- 
standing the cycle of changes in each and every case. Cycles of 
incipience, of growth, of maturation, of decay. The reason, or 
cause of the change, is to be understood before one can keep pace. 

§ 1 02. The causes at work in the dance of the imponderable 
elements. — The mutual attr action and repulsion which underlies all 
change is to be foundTrnheTe^iFTn the imponderable elements, as it 
were by definition. The active and passive qualities of the separate 
elements come into play when they are compounded, and (because 
they necessarily occur in the same "geographical" spot, and are 
only separable by mental analysis) they have to do even with physical 
state (solid, fluid, colloid, gaseous) and form (granular, amorphous, 
crystalline) and physical property (solubility and insolubility ; 
positive or negative electrical charge). Hence they may be said to 
affect the direction of movement, whether to less colloid state, or 
more colloid, to differentiation or de-differentiation, clearness or 
sharpness of reaction, or to confused state. 

§ 103. This doctrine may be brought beside the Chinese 
principle of Yang and Yin. 

To the Yang principle belong the ideas : anterior, south, rising, fecundating 
expanding, growth, advancing, strength, order, heat, motion, cheerfulness, life. 

To the Yin principle belong : posterior, north, falling, breeding, contracting 
decay, retarding, weakness, confusion, cold, rest, anger, death. 

In relation to the body : Yang belongs to the breath, the head, the speech 
the eyesight, exhaling ; the shape of the body. Yin belongs to the blood, the feet' 
the vital force, silence, inhaling ; the " body " itself. 

Yang is active, flowing, fullness, straigtitness, music. Yin is passive, tending 
to inertia, emptiness, crookedness of form, ceremonial. 

There are relations between yang and yin, and hardness or softness and the 
organs of the body. (Forke 23 , 216). 

" When the ether has the proportions of the yin, and the vang correct and & 
harmonious, there is perfection of the ether, and it is equally permeable by all "1 
five elements, as in the case of man. When the proportions are unequal, there is 
imperfection of the ether, the manifestation of the elements is unequal, as in the 
case ofjammals." — Bruce, 10 footnote: i. 115. 

§ 104. The idea of Yang and Yin swinging as a pendulum 
may add to our conception of life. The rocking of the cradle has the 
subtle purpose of throwing the yang and yin into rhythm, and the 



At- 



5 6 THE CANON OF MEDICINE 

movement of the infant's breath into rhythm, which, once started, 
will continue for at least an hour or two (See 698.) 

S 105 Urooj : NasooL™ Rise and Fall. The anabolic 
process belongs to the former ; the katabolic (formation of " effete " 
substances, their removal from tissues and organs—whether by 
deposition in tissues, as atheroma, or by discharge from the body) 
belong to the latter. These terms in Persian mysticism emphasize 
the fact of changes and movements running in cycles. Each 
individual has his own characteristic cycle of changes ; the move- 
ment of the '"' breath " goes by cycles. The life as a whole shows its 
cycle being sometimes 75 years, sometimes more, more often much 
less ' In addition there are the smaller cycles— waxing and waning 
of vital force in a certain rhythm peculiar to the person, and carrying 
with it susceptibility or resistance to infection, and the like. 

S 106 Other principles : these would be expressed as laws, 
which can'be classified into various groups— those belonging to nature 
in general ; those belonging to human nature ; those belonging to 
our conceptions of life, health, and disease. Law of qa# and qadr ; 
construction and destruction ; of distribution ; of interdependence ; 
of intention ; of compulsory visibility (discontinuous functions, etc) ; 
of desires. Note § 82. 

S 107 Cause of synchronism : namely between the two 
dancers in the simile ; these dancers being the material element and 
the imponderables respectively. This lies in the conception of 
" breath " or " life-principle," with its cycles. 

S 108 (d) Extramundane and extracorporeal influences on the 
human body "in virtue of the common content of the " four elements ." 
' That there are definite extracorporeal influences on the meta- 
bolic workings of the human body should now be intelligible. The 
effect of heat, cold, wet climate, dry climate is well enough known but 
is widely ignored, as evidenced by elaborate researches into chronic 
articular " rheumatism " being apparently made in every direction 

but this. . , 

To go further, and agree with the ancients that epidemics and 
the like had relation to planetary influences, is not necessary ; nor is 
it necessary to dismiss their possibility off-hand. It is not safe to 
argue that there is no relation between the planets and stars and lite 
on this earth simply because some relation once thought to be true is 
now discredited. If the whole universe is one organic whole, there 
cannot but be some relation. _ . 

The relation between seasonal irregularities and the interactions 
of the ' ' elements ' ' is referred to by Forke 23 (p. 298, footnote), m show- 
ing how the Chinese associated each season with the dominance of a 

given element. . , 

According to the influences prevailing at the time ot birth, so 
is the' endowment of the person born " with such an ether." L. 
" toward, the disposition is bright and good ... if untoward, not 
Chu Hsi 10 , 85. In time, and with constant self-culture, the 
inequality of etherial endowment will of itself disappear." ib., 86. 




26. 




THESIS III 

i. The Temperaments 

EMPERAMENT is that quality which results 
from the mutual interaction and interpassion 
of the four contrary primary qualities residing 
within the (imponderable) elements. 

There is a fight between the qualities ; a 
combat (Costaeus' annotation). " The temper- 
ament is something set up by contrary qualities 
as a kind of mean between them. ' ' (S. Thomas, S2 
Ixiii. p. 165, where " complexio " is rendered 
temperament ' as it is throughout the present work.) 

" How strange that the elements should be so contrary, 
And yet be forced to live together." 

Gulshan-i-Raz, 25 p. 26. 

27. _ These elements are so minutely intermingled as 
each to lie in very intimate relationship to one another. Their 
opposite powers, alternately conquer and become conquered 
until a state of equilibrium is reached which is uniform through- 
out the whole. It is this outcome that is called " the tempera- 
ment." r 

" Elementum aliquod oportet predominari in omni mixto " 83 
49, o, 1. m ; 79, 2, 2m. 

" This is a drawn battle." (Costaeus 18 .) 

shown n s^er™cfJf n T^^ the h6ading ° f this P age ' four transparent discs are 
snown superposed. The discs represent the primary qualities The tinted se?- 

SSi KSirt^ eleme ^ S - *"> C6n ^ rin S — ks off^helupef- 
different tintf c^T + gether •?• ° nS tem P«ament." As each disc revolves, 
,' ^2 -+l ST® mt ° new P 0S1 tions, and thus represent different temperaments 

oi^^^ofc^efi 1VidUA)S --- The lateral ^ S6rVe to reca11 principles 

The initial letter is taken from a French manuscript of the twelfth century. 

57 



5 8 THE CANON OF MEDICINE 

28 Inasmuch as the primary powers in the aforesaid 
elements are four in number (namely, heat, cold, _ moisture, 
dryness), it is evident that the temperaments in bodies under- 
going generation and destruction (ana-, kata-bolism) accord 

with these powers. . . 

30 A simple rational classification is into two modes : 
(a) Equable or balanced. Here the contrary qualities are present 
to exactly equal degrees of potency— neither of them being in 
excess or deficiency. This temperament has a quality which is 
exactly the mean between two extremes, (b) Inequable or un- 
balanced. Here the quality of the temperament is not an 
exquisitely exact mean between the contraries, but tends a little 
more to one than to the other. For example, to hot more than to 
cold ; to moist more than. to dry ; or contrariwise. 

" One or other proves victorious." (Costaeus.) ...,,. 

" Fire, water, earth, and air, the four elements of which bodies 
are compounded, lose their individual qualities m the compound 
bodies, and equipose (equity) is what unites them into homogeneous 
compounds." (Lahiji, 25 p. 61). -, 

'' When ... the elements attain equilibrium, the beams ot the 
spirit world fall upon them." {lb., couplet 615.) 

"When it is said that the nature of a man or thing is hot and ot 
another is cold, such statements include both the physical element 
and the immaterial principle with which they are endowed. Cnu 

' The idea of " balance " may be applied to a variety of phenomena 
in health and disease-both of body and mind. Lack of balance 
brings sickness, and explains death. Examples :— atony ; hyper- 
tonicity ; hyperacidity ; excessive trichosis ; the various phenomena 
nowadays ascribed to loss of balance in the domain of endocrine 
secretions, and hormones. The body may be too cold (subnormal 
temperature) ; the mind may be " cool ; the heart may be too 
" warm." There may be inadequate repose after mental activity, 
leading to loss of mental balance. There is dynamic balance as well 
as static balance. 

31 (It is to be noted that) a temperament, as understood 
by Medicine, is never strictly equable or strictly inequable. 
The physician should abide by the philosopher who is aware 
that the really " equable" temperament does not actually exist 
in the human being any more than it exists in any member. 
Moreover the term " equable," used by doctors in their treatises, 
does not refer to weight but to an equity of distribution, it is 
this distribution which is the primary consideration— whether 
one is referring to the body as a whole, or only to some individual 



THE CANON OF MEDICINE 59 

member ; and the average measure of the elements in it, as to 
quantity and quality, is that which (standard) human nature 
ought to have — both in best proportion and in equity of distribu- 
tion. 

As a matter of fact, the mean between excess and deficiency 
of qualities, such as is characteristic of man, actually is very 
close to the theoretical ideal. 

The fact that temperament is concerned with the primary qualities and not 
with secondary ones should enable one to avoid the idea of weight (pondus) in regard 
to the subject. In the annotation of the 1608 edition there is a reference to Aver- 
rhoes, as agreeing with this point. However, if one realises that the " elements " are 
" imponderables," it becomes self-evident that Avicenna's dissertation is correct, and 
that he himself quite realised the attitude claimed for him in this treatise. 

32. Eight varieties of equipoise :• — Human beings show 
eight varieties of equable temperament. Equipoise of this kind 
does not occur in animals, nor do these even approach to the 
equable state we describe for man. 

See also § 109 and the quotations there given, which insist on the fundamental 
difference between man and animals. 

The eight varieties are as follows : — 

A. In relation to beings other than man. (i) the equability 
of temperament seen in man as compared with other creatures ; 
(ii) that which is found in different human beings ; (iii) that which 
is taken in relation to external factors, such as race, climate, 
atmosphere ; (iv) one taken in comparison with the tempera- 
ment of extremes of climate. 

B. In relation to the individual himself. 

(v) as compared to another person ; (vi) as compared with 
the states of one and the same person ; (vii) as compared, one 
member with another ; (viii) as compared with the states of 
one and the same member at different times. 

33. We now discuss each of these modes in turn. 

i. Equability of temperament as found in man taken in 
comparison with that of other animals. The range is too wide 
to be comprehended in one definition, although there are certain 
definite limits, upper and lower, beyond which one cannot pass 
without the temperament ceasing to be a human one. 

ii. This is one which is between the two extreme limits of 
the range of temperament shown by a person throughout his 
life {p) — namely that shown at the period of his life at which 
growth has reached its limit. This, of course, is not the equilib- 
rium referred to at the outset of this chapter as only theoretical, 
and practically never found in practice — though approximating 



60 THE CANON OF MEDICINE 

closely to that. Such a person is so near to approximate equa- 
bility only as far as corresponds to the co-equation of his members, 
or the interchanging contra-action of his hot members (e.g. heart), 
with his cold ones (e.g. brain) ; moist ones (e.g. liver) with 
dry (e.g. bones). Were all these of equal influence, the resulting 
condition would be very near to one of ideal equability, though 
not so as regards each individual member, except in the case 
of the skin itself, as will be explained later. In regard to the 
breaths and principal organs, the temperament cannot possibly 
approximate to this exquisite equability ; it oversteps this m 
the direction of heat and moisture. The heart and the breath 
are the root of life, and they are both very " hot "—indeed to 
excess. For life itself depends on the innate heat, and growth 
depends on the innate moisture. Indeed the heat is present in 
and maintained or " nourished " by moisture* 

In the case of the principal organs, of which there are three, 
as we shall show in the appropriate place— the brain is cold, but 
its coldness does not modify the heat of the heart and liver. 
The heart is dry or nearly so, yet its dryness does not alter the 
moisture of the brain and liver. Neither is the brain absolutely 
and entirely cold, nor the heart absolutely and entirely dry. The 
heart is dry compared with the other two ; and the brain is 
" cold " compared with the other two. 

iii The limits of the third mode are narrower than those or 
the first, although still quite wide. This is a special equability 
peculiar to the race, climate, geographical position or atmosphere. 
The Hindus, in health, have a different equability to the Slavs, 
and so on. Each is equable in regard to their own race, but not 
in regard to others. So if a Hindu were to develop the tempera- 
ment of a Slav he would probably fall ill, and might even die. 
So, too, if the temperament of a Slav should come to be that 
of 'the Hindu, for the state of his body is contrary. So it 
seems that the various inhabitants of the earth have received 
a temperament appropriate for the conditions of their particular 
climate, and in each case there is a corresponding range between 
two extremes. - 

iv. The fourth mode is one which is a mean between the 
two limits of the range of the climatic temperament. It is more 
attempered than the temperaments of the third mode. 

v. The fifth mode presents a much narrower range than the 
first or third mode. It is the temperament peculiar to each 

* Fire "feeds on" air. So innate heat consumes the innate moisture 
(Costeus 18 ). 



THE CANON OF MEDICINE 61 

separate person, in that he is alive, and also in health. It shows 
a range between two extremes. — upper and lower. One must 
realize that every individual person has a temperament entirely 
peculiar to himself, and it is impossible for any other person to 
have an identical temperament, or even to approximate thereto. 

vi. -The sixth mode is intermediate between those two 
limits. When the person has this mode of equability of tempera- 
ment it will be the most suitable for him. 

vii. ^ The seventh mode is the equability of temperament 
characteristic for each of the several members of the body, for 
each is different from the other. In the case of bone,' the 
equable temperament has dryness more than other qualities ; 
in the case of the brain, moistness is more conspicuous ; in 
the case of the heart, warmth ; in the case of the nerves, coldness. 
Here also there is a range- — upwards or downwards — consistent 
with equability, but less than in the before-named modes. 

vin. The eighth mode is that form of equable temperament 
which is proper for each given member. When it has this par- 
ticular temperament it is in the best state possible to it. 

34. When we study the matter we find that of all beings, 
man is most near to the ideal equable temperament. Of all 
races of men, those who live in countries within the equinoctial 
circle, away from mountains and seas, approach the ideal equable 
temperament more closely than others, and those living in other 
countries. It is asserted that the more nearly overhead the sun 
is [i.e. in the torrid zone], the greater does the temperament of 
the people deviate from the ideal equability. But this is false, for 
when the sun is overhead it is less harmful, and alters the atmos- 
phere less there than it does with us, or less for those at greater 
latitudes than for us — though of course we do not have it 
overhead. 

In the case of peoples living in the equinoctial zone, the 
states of the body are in all cases more like the ideal ; the 
atmosphere in these regions exerts no evident deleterious 
effects, but is always in harmony with their temperaments. 
We have already (elsewhere) expressed our agreement with 
this opinion. 

In the case of peoples living in the fourth climate, they are 
more attempered. The sun's rays are not overhead long enough 
to scorch them, but are not as oblique as in the second and third 
zones of the earth. Such people are not exposed to cold from 
great obliquity of the sun's rays, as occurs in the case of peoples 
living at the extreme edge of the fifth climatic zone. 



62 THE CANON OF MEDICINE 

35 It has already been stated that the chief organs do not 
approach closely to the ideal equability of temperament. Of 
all members the flesh comes nearest to the ideal ; the skin 
comes next, for it is hardly affected by attempered water 
(i e water prepared by mixing equal parts of snow water and 
boiling water). It may be that the flesh is so well attempered 
because the heat of the breath and blood within it is balanced 
by the coldness of the nerves. And there is also the fact that 
it is not subject to the influence of the body itself, for the fact 
that drier and moister elements are equally present in it accounts 
for it being well attempered. We know too that its absence of 
sensation is another reason why it is not subject to the influence 
(of the body). It is only subject to intrinsic factors, or dissimilar 
qualities. For, as we know, when things have a common origin, 
but are opposite in nature, mutual interaction results, whereas 
a thing is not affected by anything whose quality is similar to 

itself (j>). . , r , 

36 The most attempered part of the skm is that of the 
hands " The most attempered part of the skin of the hands is 
that of the palms and soles. The most attempered part of the 
skin of the palms of the hands is that of the finger-pulps. The 
most attempered part of the skin of the finger-pulp is that of the 
index The pulp of the tip of the index-finger is the most 
sensitive, and that of the other finger tips is more sensitive than 
other parts, because they judge of the nature of tactile qualities. 
There must be a lessening of sensitiveness from the middle 
outwards in order that one can perceive a deviation from equa- 
bility. 

" The more the organ of touch is reduced to an equable com- 
plexion, the more sensitive will be the touch." (S.T., 84 76, 5 ; p. 44, 
trans.) 

37. In saying a medicine is of equable temperament, we 
do not use this expression in the absolute sense, because that 
would be an impossibility. Nor do we mean that it is attempered 
correspondingly to the human temperament, for in order to be 
that the medicine would have to be actually composed of human 
substance. We mean this— that when the medicine is exposed 
to the action of the innate heat within the human body, its quality 
will not over-reach either of the limits (of equable temperament) 
proper to the human being. Consequently it will not produce 
an effect beyond those limits. Therefore, in regard to its actions 
within the human body it is attempered, of equable temperament. 



THE CANON OF MEDICINE 63 

Similarly, when 'we say a drug is hot or cold, we do not 
mean an absolute heat or coldness of substance, or that it is 
hotter or colder in substance than is the human body. Otherwise 
it would imply that the drug has a temperament like that of man — 
equable. What we mean by the statement is that through the 
drug hotness or coldness comes to the body, in a degree over and 
above that degree of heat or cold which is in the body already. 
Consequently a medicament may be at the same time cold — ■ 
that is, compared with the human body< — and hot — that is, 
compared with the body of a scorpion ; it may be at the same 
time hot — that is, compared with the human body — and cold' — 
that is, compared with the body of a serpent. More than that, a 
medicament may be hotter towards the body of Peter than it is 
to the body of Paul. It is important to know this when choosing 
medicines with the object of altering the temperament. One 
must take care not to employ a medicament which from its very 
nature could not have the effect desired. 

38. Now that we have explained the subject of equable 
temperament sufficiently we pass on to consider the inequable 
temperaments (" intemperaments" dyscrasias). 

They are classified according to race, individual, and organs. 
There are eight variants, all of which agree in being contrary 
to the eight equable temperaments named above. 

(A) the simple types show a deviation from the normal 
equipoise only in respect of one contrary. 

(B) the compound types show a deviation from the normal 
equipoise in respect of two contraries at once. 

39. A. The simple intemperaments are as follows : — 

(a) where it is an active contrary quality which is in excess : 
(i) hotter than it should be, not moister or drier. 

Hot intemperament. 
(ii) colder than it should be, not moister or drier. 
Cold intemperament. 
(P) where it' is a passive contrary quality which is in excess : 
(iii) drier than it should be, but not hotter nor colder. 

Dry intemperament. 

(iv) moister than it should be, but not hotter nor 

colder. Moist intemperament. 

These four intemperaments are only temporary, for when 

too hot, the body becomes drier than it should be ; when too 

cold, the body becomes moister than it should be, by assuming 

extraneous moisture ; when much too moist, coldness supervenes 

more rapidly than dryness would. If the dryness be not very 



6 4 THE CANON OF MEDICINE 

great, the body may remain in that temperament for a con- 
siderable time, though ultimately it will become colder than 
it should be. 

It will be clear, then, that equipoise and health depend 
more upon heat than upon cold. 

So much for the four simple intemperaments. 

40. The compound intemperaments. The four compound 
intemperaments are those in which there is a departure from 
equability in respect of two contraries. Thus, the temperament 
may be at the same time hotter and moister than it should, 
hotter and drier than it should, colder and moister than it 
should, colder and drier than it should. Obviously it cannot 
be simultaneously hotter and colder, or drier and moisten 

41. Each of these intemperaments is further subdivisible 
into two forms (thus making sixteen intemperaments). {a) 
Those apart from any material substance — (qualitative ; formal). 
Here the temperament is altered only in regard to one quality, 
because the fluid pervading it has the same quality as that 
towards which the body is being changed as a whole. Yet 
it does not do so unless it be in virtue, e.g., of heat (in fever) 
or cold (extraneous cold). 

(b) Those in which some material substance is concerned 
(material). Here the body is only affected by the quality of 
the intemperament in virtue of the increased amount of some 
particular body-fluid. For instance, the body is cooled by 
vitreous serous humour ; heated by leek-green choleric humour. 

42. Examples of the sixteen intemperaments are given 
in the third and fourth volumes. 

43. Intemperaments in which some material substance is 
concerned occur in two modes : a member may be pervaded 
bv the material substance entering from without, or it may be 
pervaded by the material substance which has reached the 
tissues of the body and fails to get out through the orifices of 
the channels or from the cavities of the body. Such retention of 
material may be the beginning of the formation of an inflam- 
matory mass. 

This completes the chapter on intemperaments. 

44. The physician is again reminded that he must seek 
an explanation of the deepei intricacies of this subject m 
[esoteric] philosophy, for they are not self-evident. 



THE CANON OF MEDICINE 



65 



# 



The Temperament of the Several Members 
45. 

LLAH most Beneficent has furnished every 
animal and each of its members with a 
temperament which is entirely the most ap- 
propriate and best adapted for the perform- 
ance of its functions and passive states. — 
The proof of this belongs to philosophy 
and not to medicine. 

" An artificer produces divers works of art. (S. Thos, 84 
65, p. 186.) 

" Every creature exists for its own proper art and per- 
fection." {lb., p. 184.) 




46. In the case of man, He has bestowed upon him the 
most befitting temperament possible of all in this world, as well 
as faculties corresponding to all the active and passive states 
of man. Each organ and member has also received the proper 
temperament requisite for its function. Some he has made 
hotter, others colder, others drier, and others moister. 

§ 109. " The human body is the most noble of all lower bodies, 
and by the equability of its temperament is most like the heaven 
which is free from all contrariety." 82 (i. 70, p. 178 trans.) 

" He gave each thing its limits and all things their disposition." 
(ib., ii. 26, p. 49.) 

" God makes man after one type and a horse after another ; 
the types of things are manifold in the divine mind." (ib., i. 54, 
p. 118). 

" Lord, Thou hast ordered all things in number, weight and 
measure." (Wisd. xi. 21.) 

" There is diversity and inequality in things created — not by 
chance, not as a result of diversity of matter, not on account of 
certain causes or merits intervening, but from God's own intention ; 
in that He willed to give the creature such perfection as it was possible 
for it to have." 82 (ii. xlv, p. 108) 

We may also quote from the Chinese. — " All beings possess the 
five imponderables, but only man has them in perfect balance as the 
constitution of his Nature." " That which differentiates man from 
the brute is his possession of the Mean or Equilibrium, that perfect 
balance of the elements in the constitution of his Nature of which 
Tzu-Ssu teaches in his famous classic — the Doctrine of the Mean." 
(Chu Hsi, 11 214, 217.) 

"In the life of men and other creatures, the Nature with which 
they are endowed differs from the very beginning in the degree of 



66 THE CANON OF MEDICINE 

its perfection. But even within the differing degrees of perfection 
there is the further variation in respect of clearness andtranslucence." 

(ChuHsi, 10 i., p. 57-) :,.,.. J , • * ■ i ' ■ • i 

" When the ether received is limited, the immaterial principle 
received is also correspondingly limited. Thus, the physical constitu- 
tion of dogs and horses being as it is, their functions are correspond- 
ingly limited in their range," (#., p. 6o.) " Man receives the ether 
in its perfection, and the ethical principle permeates it completely 
and without impediment ; while in the case of other creatures, m 
which it is imperfect, the ethical principle is impeded and un- 
intelligent. He receives the ether of the universe in its perfection, 
and therefore possesses moral and intellectual faculties." (p. 67.) 
" In birds and animals, though they possess the Nature, it is 
restricted by the corporeal element, which creates an impenetrable 
barrier" 10 (p. 61.) 

47 o In order of degree of Heat. 

1. The Breath is the hottest, and the heart in which it 

arises. 

2. The Blood. Though this is generated in the liver, it 

derives more of its heat from the heart than from 
the liver, the two organs being in continuity. 

3. The liver, which may be looked upon as concentrated 

blood. 

4. The " flesh," which would be as hot as the liver were 

it not for the nervous tissue (cold temperament !) 
which pervades it. 

5. The muscles which are cooler than the " flesh " 

because of their tendons and ligaments, as well as 
the nerves. 

6. The spleen. The faex of the blood makes this colder. 

7. The kidneys contain relatively less blood. 

8. The walls of the arteries. These are warm in spite 

of the nerve substance present, because they receive 
heat from the blood and the breaths within them. 

9. The walls of the veins, which owe their heat to the 

blood alone. 
10. The skin of the palms and soles. 
48, In order of degree of Coldness. 

1 . The coldest thing in the body is the serous humour.— 
2. Next in degree, the hairs. — 3. The bones. — 4. The Carti- 
lage. — 5. The ligaments.— 6. Tendon.— 7. The membranes. 
8. The nerves. — 9. The spinal cord. — 10. The brain. — 11. 
Fat. — 12. The oil of the body. — 13. The skin. 

(In general, organs rich in blood are of hot temperament ; 
those poor in blood are of cold temperament. — Aegineta.) 



THE CANON OF MEDICINE 67 

49. In order of degree of Moisture. 

1. The serous humour is the most moist constituent of 

the body. — 2. The blood. — 3. The oil. — 4. The fat. — 

5. The brain. — 6. The spinal cord. — 7. The breasts and 

testicles. — 8. The lung. — 9. The liver. — 10. The spleen. — 

11. The kidneys. — 12. The muscles. — 13. The skin. 

The order here given is that of Galen, but in the case of 

the lung the moisture is not inherent in its nature but is derived 

from the nourishment which comes to it. The lung is fed by a 

very " hot " blood, because there is much bilious humour in the 

blood going to the lung. A great excess of moisture accumulates 

in the lung from the gaseous products of the whole body as well 

as from the materials which flow down to it from the " head." 

In actual fact the liver is intrinsically moister than the lung, 
whereas the lung is as it were constantly sprinkled with moisture ; 
it is the fact that the moisture lingers in it that makes it so soft 
(to the feel). 

One should conceive of the states of the serous humour 
and blood in a similar way. The serous humour is moist in that 
it is as it were sprinkled with moisture. In the case of the blood 
the moisture interpenetrates, pervades, and grows through its 
very substance. It is true that the serous humour, watery in 
nature., generally possesses much more moisture in itself than 
the blood does. And if the digestive changes in the blood proceed 
inadequately it loses not a little moisture — namely, the moisture 
of the naturally watery serous humour, which has become part 
of the blood. As we shall see later, the normal serous humour 
is nothing more than imperfectly digested blood. 
50. In order of Dryness. 

1. The driest thing in the body is the hair, for this comes 
from the ethereal element carrying up with it the material 
dispersed to it from the rest of the body, which is then left 
behind in the hair as pure fumosity. 

2. The bone. This is the hardest of all the members. 
It is however moister than hair, because bone is derived from the 
blood, and its fume is dry, so that it dries up the humours 
naturally located in the bones. This accounts for the fact that 
many animals thrive on bones, whereas no animal thrives on 
hair— or at least it would be a very exceptional thing if hair 
ever did provide nourishment. Some think that bats can digest 
hair and live on it. The proof that bone is moister than hair is 
that when equal weights of bones and hair are distilled in a retort, 
more water and oil will flow and less " faex " will remain. 



68 



3- 

4- 

5- 
6. 

7- 
...8. 

9- 

io. 

1 1. 

12. 



7W.E CANON OF MEDICINE 

Cartilage. 

Ligaments. 

Tendon. 

Serous membranes. 

Arteries. 

Veins. 

Motor -nerves. 

Heart. 

Sensory Nerves. 

Skin. 



The motor nerves are colder and drier at the same time, 
and are therefore in equipoise. The sensory nerves are colder 
but not drier in proportion, and are probably very nearly in 
equipoise, since their coldness is not very far distant from that of 
the motor nerves. 

§ no. Link between soul, passions, temperament. S.Thomas 84 
writes (ii. 63, p. 166) : " The soul rules the body, and curbs the 
passions that result from the temperament. For by temperament 
some are more prone than others to desire or anger, and yet refrain 
more from these things." 



3. The Temperaments belonging to Age 
Sex, Place of Residence, Occupation 
51. There are four periods of life. 



Period. 


Title. 


Name. 


Years of age. 


I. 

II. 

III. 

IV. 


The period of growth. 
The prime of life. 
Elderly life. 

Decrepit age. 


Adolescence. 
Period of beauty. 
Period of decline. 
Senescence. 
Senility. 


Up to 30. 
Up to 3 5 or 40. 
Up to about 60. 

To the end of 

life. 



In the third period, the best vigour has passed, and the 
intellectual power begins to decline. 

In the fourth period, vigour and intellectual power both 
obviously decline. 

52. The First Period of Life. 



THE CANON OF MEDICINE 



6 9 



Sub- 
division 



Name. 



First. 
Second. 

Third. 

Fourth. 
Fifth. 



Infancy 
Babyhood. 

Childhood. 



Juvenility. 
" Puberty." 
Youth. 



Distinctive Characters. 



The period before the limbs are fitted for 

walking. 
The period of formation of teeth. Walking 

has been learnt, but is not steady. The 

gums are not full of teeth. 
The body shows strength of movement. 

The teeth are fully out. Pollutions have 

not yet appeared. 
The period up to the development of hair 

on the face and pubes. Pollutions begin. 
The period up to the limit of growth of the 

body (to the beginning of adult life). 

Period of athletic power. 



The temperament during the whole of this period of life 
is almost equable as regards " heat," but " moisture " is in 
excess. There has been not a little controversy among older 
writers about the degree of heat during the period of juvenility 
as compared with that of youth. Some argue that the heat is 
greater in the former than the latter, and that this accounts for 
their growth, and for the fact that their natural functions of 
appetite^ and digestion are greater in vigour and persist longer. 
This, it is considered, is due to a condensation of the innate heat 
derived from the sperm. 

53. Others argue that the innate heat of youth is far 
greater than that of juvenility, because (a) their blood is much 
more plentiful and is thicker. — evidenced by the frequency with 
which nose-bleeding occurs ; (F) their temperament approaches 
that of bile, whereas that of juvenility approaches that of serous 
humour. ^ (The evidence of an undue proportion of bilious 
humour in a temperament is (i) that the diseases in such a person 
are " hot " — e.g. tertian fever ; (ii) the vomitus is bilious ; (iii) 
other facts.) (c) The movements of the body are more energetic 
m youth ; and bodily movement requires plentiful innate 
heat, (d) Digestion is better and more vigorous ; and this 
entails expenditure of heat. The signs of a vigorous digestion 
are :_ absence of feeling of nausea ; absence of fermentative 
vomiting ; absence of crudity or aversion to food. These occur 
in juveniles when their digestive power is disturbed, (e) The 
appetite is less in youth than in juvenility. This shows that the 
innate heat is greater, for the appetite is better in a cold tempera- 
ment. A dog's appetite is often accounted for by cold tempera- 



70 THE CANON OF MEDICINE 

ment. (f) The process of growth, greater in juveniles, requires 
adequate moisture rather than heat, (jf) The diseases to which 
juveniles are liable are usually cold and moist ; and when fevers 
occur in them, they are pituitous. If vomiting occurs it is usually 
serous. 

These then are the two theories and the facts on which they 
are based. 

54. Galen s teaching. — Galen is opposed to both. In 
his opinion the heat is actually the same in each. The difference 
is that in puberty its quantity is great but its acuity is less. In 
youth the heat is less in quantity but greater in acuity. As he 
says — let us imagine first a single measure of " heat," or a subtle 
body of unit heat, penetrating into an abundance of moist 
substance — as it might be, water. Then imagine a unit of 
heat penetrating into a small bulk of stone. The heat in the 
water would then be large in quantity but soft in quality, whereas 
the heat in the stone would be less in amount but of great acuity. 
This is analogous to the state of affairs in regard to the heat of 
juvenility and of youth. 

55. Juveniles derive their (innate) heat from the sperm, 
which is very " hot." This initial innate heat is being steadily 
used up, but the loss is made up by the progressive growth ; 
indeed it is more than made up. — But during the period of youth, 
there is nothing to make good such loss of innate heat. On the 
contrary, the degree of innate moisture is lessening both in 
quantity and quality, — this being the mechanism by which the 
innate heat remains at a constant level up to senescence. Ulti- 
mately, the moisture is in too small a proportion to enable the 
innate heat to be maintained constant. During all this period 
there is no corresponding growth. — At the outset of life, the 
innate moisture suffices for the two requirements — maintenance 
of innate heat ; growth. But there comes a time when one or 
other or both must fail. Innate heat must be adequate to enable 
growth to take place, yet the basis of growth — innate moisture — 
is failing. So how can growth possibly continue ? It is clear 
then, that growth must cease, for it cannot be that the innate heat 
should be sacrificed. This is " the tongue of the case " m (iii. 
347) during the period of youth. (/>.) 

56. As regards the second theory — that during juvenility 
growth is in virtue of moisture rather than in virtue of heat ■ — This' 
cannot be true because moisture (m) is the material cause of 
growth and m does not unfold or construct itself ; it is not a self- 
created " being " ; it only changes in virtue of a formative power 



THE CANON OF MEDICINE 71 

(/) acting upon it. As a matter of fact this formative power is F — 
the " soul," or " nature " — -that which is in the decree of Allah 
('umr-i-Allah). This " nature " requires an instrument where- 
with to work, and this instrument is the innate heat. 

57. So, when people assert that the voracious appetite of 
juveniles proceeds simply from their cold temperament, this 
also is wrong. A morbid appetite due to coldness of tempera- 
ment cannot result in good digestion and nutrition. As a 
matter of fact the digestion during the age of juvenility is usually 
of the very best. Growth of the body as a whole implies that 
more food is being assimilated than is used up. When digestion 
is faulty, the cause is either (a) gluttony, eating food voraciously 
or inordinately ; or (b) errors of diet — partaking of a diet badly 
designed and including articles of food which are unwholesome, 
or moist in temperament, or in excess ; (c) neglect of the move- 
ment of the bowels and other emunctories, whereby effete matters 
accumulate and become knit together in them (which is an 
indication for purging) — (d) other emunctories : the lungs 
especially need ' ' purgation ' ' by making the respiration deeper and 
quicker ; although its power is never as great as it sometimes is 
in the second period of life. 

This completes Galen's teaching about the temperaments 
of juvenility and youth. 

58. One must also bear in mind that the innate heat of 
the body begins to fail after the prime of life, because the ambient 
air dries up the moisture of the body. — and the moisture is m of 
of the body.* 

The innate heat also helps to dry up this moisture. So 
also does the effort involved in the performance of the corporeal 
and emotional activities inevitably associated with life. 

59. Drying up of the moisture is also aided by the failure 
of the " nature " to withstand the steadily and silently increasing 
dissipation of the faculties. All the faculties of the body are 
finite in duration, as is well-known to natural science. So also 
the innate heat is not being replaced for ever. Even were the 
innate heat infinite in duration and always bringing about its 
changes in the body, so as to maintain a renewal equal to the 
loss, the fact that the loss is increasing steadily day after day 
inevitably leads to a limit beyond which the loss could not be 
made good. A fixed state of dryness would be bound to come. 
How much sooner would not this time arrive did both factors 
contribute simultaneously towards it ? 

* The body is admittedly 95 per cent, water 1 



7 i THE CANON OF MEDICINE 

60. We see- then that the m, the moisture of the body, 
must inevitably come to an end, and the innate heat become 
extinguished — and the sooner if another contributory factor to 
its destruction be present ; to wit, the extraneous excess of 
humour arising out of imperfect digestion of food. _ This 
extinguishes the innate heat (a) by smothering it, enclosing it, 
and (b) by providing the contrary quality. This extraneous 
humour is called the " cold serous humour." 

61. This is the death of "nature " to which every person is 
destined, and the duration of life depends on the original tempera- 
ment, which retains a certain degree of power to the end by 
fostering its intrinsic moisture. This is the person's appointed 
end, and the diversity of temperaments accounts for the different 
durations of each one's life. These are the natural terms of 
life. (There are of course, also, premature deaths, brought 
about through other causes, though even these are also in accor- 
dance with Divine Decree.) 

" All things have We created after a fixed decree." (Q. 54, 49.) 

" The four elements are as birds tied together by the feet ; 
Death, sickness and disease loose their feet asunder. 
The moment their feet are loosed from the others, 
The bird of each element flies off by itself. 
The repulsion of each of these principles and causes 
Inflicts every moment a fresh pang on our bodies. 
That it may dissolve these composite bodies of ours, 
The bird of each part tries to fly away to its origin ; 
But the wisdom of God prevents this speedy end, 
And preserves their union till the appointed day." 

Mesnavi, " p. 162. 



§ ill. The " death of nature " may also be explained on the 
basis of urooj and nasool (§§ 105, 137), for when the positive and 
negative phases in the cycle of the elements and of the breath clash — 
that is, enter the phase of kemal (Persian term) the bodily functions all 
cease. The kemal phase may be reached long before the allotted 
span. 

§ 112. The presence of this phase, and its probable duration 
before death actually occurs, may be discerned in practice, if the lav- 
be understood. This fact throws a significant light on the state- 
ments in the Chinese work on the pulse, 98 where the time of death 
is foretold from the study of the pulse and other factors—assigning 
not a number of hours, or days, but a particular period in the lunar 
cycle. Chu Hsi, 11 in ascribing the varying fortunes of individuals 
during their life to differences of endowment of Ether (p. 217) 
betrays a knowledge of the cyclical changes pertaining to body and 
mind, as well as to the outer world at large. 

§ 113. It would be fallacious to argue from this that skil- 



THE CANON OF MEDICINE 73 

ful prognostication of this kind . would render medical . treatment 
superfluous. The value of realizing these phases lies in the under- 
standing with which measures are applied in order to tide over the 
patient during the dangerous period of inertia of vitality, breath or 
other factors. ' 

This would not dispense with the constant sense of "fiat 
voluntas. Tua," both on the part of the lay and of the profession 

Quotations from the Chinese, for instance, in whom the con- 
ception or belief in Fate is vivid and almost dominant, brings no 
conviction to those many who claim to have no belief in Fate whatever 
Nevertheless a few proverbs may be quoted, as expressing the 
conception usefully : " there is a day to be born, and a time to die " • 
"before life has been, death has been appointed." "In the beginning 
it was decided whether one should have long or short life • whether 
one should have honour or poverty." " The swallow living in the 
hall does not know the great building is about to be burned " " t± 
physician may cure disease, but he cannot heal Fate." " The lucky 
physician sees the patient at the end of the disease ; the unlucky 
physician sees the patient at the beginning of the disease." 
(Plopper, 76 , chap, xi.) 

No doubt where a possibility of " destiny " is to be admitted for 
one iorm of circumstance, the application of the same principle to 
many details of human life is not so readily conceded; That it i«s 
allowable for much more than is customarily accepted will be credible 
when the existence of occult and inscrutable chains of causes or 
attractions operating together is realized. 

Fate is supposed by some to be blind ; by others to be the decree 
of a far-off Potentate. It is neither. It is the manifestation of a 
series of combinations of conditions which by " natural " courses 
of sequences operate in the individual human life. Everyone shares 
in the weaving of his own web. The web is a by-product in some 
great scheme which we need not question. Fate ceases to signify 
for such as rise into the Scheme itself. For, to them, their life is as 
the throwing of the stone unerringly into the bull's-eye • the inter- 
vening events, the debris, what of them ? 

§114. Rather than criticize severely the idea of the length of in- 
dividual human lives being preordained, Anwari 25 rightly asks (p. 54) 

" If destiny be not the arbiter of mundane affairs, 
Wherefore are men's states contrary to their wishes ? " 

" Who, then can say, ' I am an individual, independent and free 
1 can think what I wish, and I can do what I wish ' ? You are not 
doing what you wish . . . thinking what you wish ! There are 
various thoughts around you in the form of men and animals, who 
influence your mind and feeling and thought ; you cannot escape 
them. . . . There is always some person stronger than you and 
always someone weaker than yourself. . . . Our lives are tied 
together and there is a link in which we can see one current running 
through all." Rosegarden, 38 1st ed., p. 52. 

§115. No doubt "destiny" is often supposed to negative 



74 THE CANON OF MEDICINE 

"freewill" which is so much insisted on as man's prerogative. 
Destiny belongs to the body, freewill to the soul. Or, to be more 
accurate it is our Will which is important and not the body, or its 
length of life Or, to be still more accurate, by employing the 
algfbraic symbols already fixed on-we are born MF ; from that 
moment, with each further reception of (feeding on) sights and sounds 
oTSher' sense-impressions, we become MF' But the purpose of 
human life has been shown to rise quite beyond this, and our goal is 
toTecome MF" before we die. In each case M goes into corruption, 
but the position of F' and F" is vastly different 

» The voices of Nature are the mother of the soul _ * is the 
outcome of a consistent usage of << freewill " by the Will m a certain 
direction-namely supernatural, combined also with a feeding 
(to use the same term as above) on supernatural impressions. 

To quote from theology, in which domain we are brought 
"supernatural" does not refer to superstitions evil practices, and 
hypothetical experiences ; it is a term used in the sense of super- 
natural grace " The ordinary human being is body plus rational 
soul in the natural order ; but it has been intended that he shall be 
body Plus rational soul in the natural order plus soul in the super- 
natural order (Irenaeus). " There should be no clash between the 
natural order and the supernatural, for both own God for their 
Author and one great function of grace is to supernatural^ the 
rTtural'life of man by the love of Christ." (O. R. Vassall-Phillips 
r SS R 98 o ^i 12) Wherein lies the importance tor a proper 
attitude by the physician towards his patient, in regard to the serious 
moments of life (among others), when deceit, equivocation, and 
concealment of the gravity of the malady are to be deprecated. 

62 To sum up, the equable temperament of the period 
of juvenility and youth is " hot," whereas that of the last two 
periods of life is " cold." The body in juvenility is additionally 
of a moist (equable) temperament, in that growth is proceeding ; 
the moistness is shown by the softness of their bones, nerves and 
other members, and by the fact that at this age it is not going to 
be long before the semen and ether will come to manifestation. 
Old persons and those in the " decrepit " age are not only colder 
but drier in temperament. This is evidenced by the hardness 
of their bones, the roughness of their skin, and the long time which 
has elapsed since they produced semen, blood, and the vaporai 
(ether) breath. . , , 

Theory 1 ualit 3 is in e q ui P oise durm g J uvenlllt y and 7°^ 
but the airy and aqueous quality is more abundant m juveniles. 
In old persons and in the decrepit, the earthy element is more 
predominant than in the other ages. This element is most 
marked during the decrepit age. 



THE CANON OF MEDICINE J5 

p. i62J Earth ^^ t0 ^ 6arth ° f the h0d y [ retum to thy root." (Mesnavi, « 

_ The temperament of youth is nearer to equipoise than that 
of juveniles^ but compared with them, its temperament is dry • 
compared with the third and fourth periods of life, the tempera- 
ment of youth is moist. v 

The temperament of the decrepit period is drier than in 
youth and that of the third period of life in regard to the single 
members, but more moist than either in regard to extraneous 
moisture. ° 

63. Temperament in Relation to Sex. 

[p^im^^oi^^^^ &mm&Im ,^ t * hat is , h 
female is smaller than the male. The female is also mister 
The coldness of temperament, as well as the habit of^Iyin^at 
home and taking so little exercise, accounts for the accumulation 
of excrementitious matters in the female. Their " flesh " is 
more fine in ''substance" (texture) than that of the male, though 
the flesh of the male is more rarefied in virtue of that which is 
admixed with it. The denseness of male flesh renders permeation 
through its veins and nerves more difficult. 

P^ T 64a T *™ament in Regard to Geographical 
««rZ7' , e tem Pf/ ment fiSoister_in the peoples inhabiting 
northerly countries, ccJdexin those living in southerly countrief 

to* Iemperament in Regard to Occupation — 

1 he temperament i^moisterjn those who follow a maritime 
occupation ; others are contrary. 

66. The Signs of the Temperaments are discussed under 
the general and special signs and symptoms. 



THESIS IV. THE HUMOURS 




UMO URS : Fluids of the body. § 1 16. The word 
"humour" does not now bear the sense which 
formerly made it an exact equivalent of humor. 
In German, " Saft "■would still apply, but "juice" 
is unsuitable for the present translation. The term 
" fluids of the body" has been selected though 
requiring some qualification. Thus, the humour 
named " sanguineous " (72), or, simply, " blood " is not to_ be 
regarded as identical with the fluid drawn, say by venesection, 
and studied before or after clotting. The phlegma is not properly 
represented by either " phlegm," " mucus," or " lymph, though 
having some resemblances to each. " Serous humour has been 
preferred to the older " phlegmatic humour." Similarly, yellow 
bile " in the Canon may not be restricted to the fluid in a normal 
gall-bladder ; and " black bile " cannot be made synonymous with 
(black) pathological gall-bladder contents. 

Furthermore, it should be said that the " humours are quasi- 
material. In many passages of the Canon it would seem that when 
" matter " is spoken of, in connection with disease, humour is 
often meant, and particularly a morbid humour. But it is also clear 
that behind the humour there is what Paracelsus would call an 
" essence," or " radical humour," which itself governs the nature of 
the humour and whether or not it is going to become morbid. On 
such a view health depends on the maintenance of the essential 
humour in a state of purity. ..-,,, r 

Again, we may say that the blood is the salt principle ot 
the body, the serous humour the " sweet principle," the bilious 
humour the " bitter principle," and the atrabilious humour the sour 
principle " of the body. According as one or other of these is pre- 
dominant in a person, so is his constitution or temperament. In 
addition to this, the view of the nature of a humour may be extended 
by suggesting, for instance, that fatty acid is an essential of choleric 
humour, whereas neutral fat is an essential of sanguineous humour ; 
that sulpho-centric substances are an essential of atrabilious humour. 
§ 117. The idea belonging to the doctrine of the humours is 
not affected by biochemistry or cytology, any more than the theory of 
" four elements " is really affected by modern chemistry. To retain 
the idea is to claim a practical value in drawing a distinction between 
" humours " and the body-fluids. In 101 Avicenna speaks of the' 
blood as a product of the liver, the material for its manufacture bemg 
derived almost directly from the food itself. As to the blood-cells, 

76 



THE CANON OF MEDICINE n 

had he known of them he might justly still regard them as incidentals • 

as forces accresced_ for a time, and always changing in substance.' 

After all they are importations into the blood ; whatever tissue be 

their real source, whether their origin is local or widespread, they 

are not the real trouble in anemia. Remedies will increase their 

numbers, but do not touch the real disorder. From Avicenna's point 

of view, it might be said that the glamour of the revelations of the 

microscope has only diverted attention from the real " sanguineous 

humour and its ultimate sources and similar subtleties, therebv 

leading treatment away to " attacks " on the red and white cell 

forming organs For the blood is itself living— not a mere chemical 

conglomerate. Hence m this field there is a need for reverting to 

the old paths The constant endeavour also to reduce everything to 

terms of cellular individualities, as opposed to one single complex— 

the human being, the one single MF— inevitably carries errors in its 

When S. Thomas wrote " Health is a harmonv of the humours " 
[banitas est quaedam harmonia humorum) 81 -? 2 (ii 64 p 166) he 
was so near the truth as to maintain his place even in these days of 
excessively refined details of knowledge. 

1.— What a Body-Fluid (Humour : Akhlat) is, and how 
many Kinds there are. 

67 ;> A body-fluid, or "humour" is that fluid moist 
body into which our aliment is transformed. 

Healthy, or " good " humour (whether present in the ali- 
ment in a pure state or admixed) is such as has the capacity for 
becoming transformed into actual body-substance, either by 
itself or in combination with something else. In short it is 
that which replaces the loss which the body substance' (con- 
tinually) undergoes. 

wl - +1n Jf 0m tlie , above definition, it is clear that " body-fluid " is not synonymous 
with humour. Urine, too, though a fluid, is not a humour.— In a sense b^dv 
fluids are the meeting-places between various opposed forces or elements and S 
chemical composition is the mode in which such forces or element are expressed 
paragrlpr 6 ' *** ^"^ does not <^m to the wording^ IT, above 

68 The residue from such, the " superfluity," is called 
unhealthy or bad ' humour. This is contrary in capacity to 
the former, and is only exceptionally convertible into good 
humour. It is proper that it should be expelled from the body 
instead. J 

w o + ThS familiar P hrase s /' good-humoured," "bad-humoured" of modern con 
versation may not have the same significance to the speakers as ?hev had Tn 
Shakespeare's day, but retain their value. Y ad 1Q 



7 8 THE CANON OF MEDICINE 

69. Some of the fluids are primary ; some are secondary. 
The -primary fluids of, the body are : the sanguineous 

humour, the serous humour, the bilious humour, and the 
atrabilious humour. 

The secondary fluids of the body are : — 

(a) non-excrementitious : 

i. located at the orifices of the minutest channels 
near the tissues, and thus irrigating them. 

ii. permeating the tissues like a dew and capable 
of being transformed into nutriment as required. 

iii. an almost congealed fluid. 

iv. a fluid existent among the tissue-elements from 
birth. 

(b) excrementitious. " Superfluity." Forms of the re- 
spective primary fluids. 

70. As regards the non-excrementitious fluids, these 
have not yet been subjected to the action of any of the simple 
members ; not till they reach the tissues for which they are 
destined, are they changed. (j>). 

Of the four varieties above named, the second moistens 
the tissues according to the requirements which active move- 
ments entail, and it comes into play if there is anything likely to 
dry up the tissues. The third variety forms a nutriment 
which will be changed into the substance of the tissues, 
whether to the extent of entering into their temperament, 
or to the extent of changing into their very essence, thereby 
attaining an entire likeness to the member. The fourth type 
accounts for the continuous identity of the member or of the body 
throughout life ; it arose with the sperma. It is however true 
to say also that the semen (bojJajr^^^ 
humours. 

71. The Four Body-Fluids or Humours Proper. 

i. The sanguineous humour, the most excellent 
of all. 

2. The serous humour. 

3. The bilious humour (lit. " red bile "). 

4. The atrabilious humour (lit. " black bile "). 

72. The Sanguineous Humour. 

In nature (that is, considered dynamically) the blood is hot 
and moist. In character it either conforms to its nature or it 
does not. That is (we may say) it is " normal " or " abnormal." 



THE CANON OF MEDICINE 79 

Normal " blood " is red in colour, has no unpleasant odour, 
and has a very sweet taste. 

When blood is abnormal, it is either (a) because the good 

temperament has become intrinsically altered or vitiated' ■ 

i.e. has become colder or hotter ; but not from admixture with 
any foreign matter, or (b) because an unhealthy body-fluid is 
admixed with it. "This may happen (i) by an unhealthy fluid 
corning to it from without, penetrating it and so causing decom- 
position in it, or (ii) by a putrescent change in a portion of itself 
— the rarefied product becoming bilious humour, and the denser 
product becoming atrabilious; either one, or both together, may 
remain in the blood. Abnormal blood of type (i) is named 
according to (a) that which is admixed with it — whether serous 
humour, or atrabilious, or simply bilious fluid. That of type (ii) 
is named according to (b) its colour and wateriness — sometimes 
it is turbid, sometimes attenuated, sometimes very dark from 
much blackness, sometimes pale, (c) taste and odour — bitter, 
salt, or sour. 

§H7« " Blut ist ein ganz besondrer Saft." 

The blood may well be regarded as comprising : sanguineous 
humour, corpuscles, the canalicular system of the whole body, and 
the tissue-elements abutting thereon ; that is, as including the 
lymphatic channels and their floating cellular population. In 
addition, there are the blood-forming centres, which are the meeting- 
point of two vitalities— the livingness of the blood and the livingness 
of the tissues. The hsemopoietic centres are foci disseminating 
vital force," as also are the endocrines, the abdominal ganglia, etc. 
The energies so well-known as chemical, physical, osmotic, etc.', are 
not primary, but conversions from the living force of these centres. 
When the blood changes, or its cell-formula changes, it is because the 
vital force is changing its mode : instead of radiating in one way, it is 
disintegrating in other ways, and it involves some one organ more 
than usual. The balance of action on organs, and the balance in 
interchange now ceases to be "just," and the organ or organs 
concerned therein are then apt to receive the brunt of the physician's 
attention. 

73. The Serous Humour. 

In nature, this is cold and moist. We describe a normal 
form and an abnormal. 

Normal (" sweet ") serous humour is such as is capable of 
transformation into blood at any time, seeing that it is in fact 
an imperfectly matured blood. It is a sort of " sweet "* fluid 
which is not in too cold a state; that is, it is cold compared with 

* We may note that it is still correct to call a discharge " sweet." 



8o THE CANON OF MEDICINE 

the blood and bilious humour, but hardly at all cold compared 
with the body as a whole. } A " sweet " serous humour may 
change into one which is insipid, and abnormal, as we shall 
describe presently. This happens when there is normal blood 
admixed — as occurs often in catarrhal exudates or discharges, 

and saliva. 

Sweet serous humour (lymph) has no special locus or recep- 
tacle in the body, any more than the two bilious humours have. 
Yet the serous humour resembles blood closely in this that it is 
equally necessary for all tissues, who receive it along with the 

blood. 

The tissues absolutely require serous humour for two reasons 

— one being essential, and the other accessory. 

The essential function is two-fold : (a) that it should be 
near the tissue (cells) in case they should be deprived of their 
habitual nutriment (viz., healthy blood) by reason of retention 
of the material in the stomach or liver from some cause. This 
material is normally acted upon by the vegetative faculties, which 
change and digest it and are themselves maintained thereby. 
The transformation of lymph into blood is achieved by the innate 
heat. Alien heat would only putrefy the material and decompose 
it. This kind of relationship does not obtain in the case of the 
two bilious fluids, because neither of them turns into blood at any 
time, as the serous humour does, under the influence of the 
innate heat ; but they resemble the serous humour in under- 
going putrefaction and decomposition under the influence of 

" alien " heat.* . 

(b) it must be admixed with sanguineous humour before it 
can reach and nourish tissues of lymphatic temperament. When 
the serous humour is present in the blood for subserving nutri- 
tion, it must be in definite proportion before it reaches the parts 
to be nourished ; e.g. the cerebrum. It is the same in the case 
of the two bilious humours. 

The accessory junction is that of moistening the joints and 
tissues and organs concerned in movement, for otherwise the 
heat of the friction of the movement would produce dryness of 
their surfaces. This function is within the range of necessity. 

* For "alien heat" we should now read "bacterial infection." 



74. 
Sweet. 



THE CANON OF MEDICINE 
Table of Forms of Serous Humour. 
i. Normal. 



ii. Abnormal 

A. — Arranged according to the Taste. 



No. 



Description. 



Sweet. 



2 


Salt. 


3 


Acid or Sour 


4 


Bitter 


5 


Insipid. 



Remarks. 



(i) Outcome of action of the vegetative 
faculties ; 

(ii) Due to admixture with blood. 

Due to admixture with bile, " bilious 
serous humour." 

(i) Intrinsic in origin ; 

(ii) due to admixture with acrid atra- 
bilious humour. 

(i) From undue infrigidation ; 

(ii) from admixture with atrabilious 
humour. 

Attenuated serous humour. 



Temperament. 



Hot and moist. 

Hot and dry. 
Cold and dry^ 



Cold and moist 



B - — Arranged according to Essential Nature. 



No. 



6 
7 



9 
io 



Description. 



Watery. 

Excrementitious 
or Mucilaginous. 
Crude. 



Vitreous. 
Calcareous. 



Remarks. 



Attenuated serous humour. This may be salty if 

there arise m it some sort of putrescence 
A superfluity of foreign nature, and evident as such 

to the senses as a mucilaginous material. 
This is a subvariety of the preceding ; to the senses 

it appears to be the same as the preceding but 

actually is different. -- 6 ' 

Glasslike in texture ; taste sometimes sour, sometimes 

absent. 
Opaque white. Denser than the " crude " form 
ihe attenuated part has been dispersed ; that which 

is denser than all the others therefore lingers too 

long m the foramina and joints. 



the same order as the. Latin text, though including all the information therein ) 

The abnormal forms of serous humour (see also 74). 
75. Salty serous humour (No. 2 in table), is warmer, drier 
and lighter than any of the others. It is salty because oxidized 
earthy matters of dry temperament and bitter taste are admixed 
with the watery (nearly or quite insipid) "moisture," in equal 
proportions I say "equal " (i.e. in potency, not weight. Tr ) 
because ii the earths were in excess, the taste would be bitter 
rather than salt The same sort of process accounts for the origin 
or the salts in all the salty waters found in Nature. 

76. Salts may be obtained artificially also, by boiling- 
ashes, soap ashes, or chalky matter, etc, in water. Then strain. 



82 THE CANON OF MEDICINE 

The salt will then separate out from the water, either at once, 

or on standing. . rr ... 

77 Attenuated serous humour (No. 5, 6) is similar, lnis 
may be'insipid or have only a slightly salt taste. This taste 
results from the admixture with an equal amount of oxidized 
bile, which is dry and bitter ; and the resultant heating 
salty fluid is called" bilious serous humour. Though Galen 
believed that this kind of serous humour owed its saltiness to 
admixture with putrescence or wateriness, my teaching_ is _ that 
the putrescence makes it salty by setting up oxidation m it, in 
consequence of which an "ash" becomes admixed with the 
moisture. Aquosity by itself is insufficient to render serous 
humour salty; some other factor must be present, either as well 
or on its own account. 

78 Serous humour (No. 4) becomes Utter if (1) atra- 
bilious humour (which is bitter) be admixed with it, or (11) too 
much infrigidation takes place, whereby the taste changes from 

sweet to bitter. 

The process consists in a congealing and degradation of the 
watery element into something dry, and therefore earthy m 
character. The degree of heat is too small to ferment it and 
make it sour. A strong heat would completely alter it (into 
something else altogether). 

79 Sour or acid (No. 3). As in the case of sweet humour 
there are two forms— one where the sourness is intrinsic m 
oriein • and one where it is introduced from without. In the 
second'case it is acrid atrabilious humour that is the extraneous 
factor We shall speak of it later. When the sourness is 
intrinsic, it is comparable with the change that takes place when 
the other juices go sour. In other words, it is sour because the 
humour has fermented and then gone sour. 

80. No. 6. See under No. 2. (No. 7 and 8 are described 

in the table.) \ ■ a 

81 The vitreous kind of serous humour (No. 9) is dense 
and clos'elv textured, and resembles glass in viscosity and weight. 
It is sometimes sour to the taste and sometimes tasteless. _ 

When a humour like this is closely textured and insipid, 
it either is " crude," or changes into a crude serous humour 
The vitreous humour was originally a watery humour, and 
" cold " • and remained so without undergoing putrescence, 
or having any other thing admixed with it. All this time it is not 
manifest to the senses. It becomes evident only when it thickens 
in texture, and develops coldness. 



THE CANON OF MEDICINE 



83 



3. The Bilious Humour. 

In nature this is hot and dry. It also occurs in a normal 
and an abnormal form. 

82. Natural bilious humour is the " foam " of blood. It 
is bright red in colour. It is light and pungent. The redder its 
colour the hotter it is. It is formed in the liver, and then pursues 
one of two routes— either it circulates with the blood, or it 
passes on to the gall-bladder. The part which passes into the 
blood-stream subserves two purposes— Q) it enables the blood 
to nourish those certain tissues or organs which need the presence 
of a suitable amount of bilious humour in a dispersed form : as 
holds in the case of the lung, (ii) a mechanical one. It attenuates 
the blood (i.e., diminishes its surface tension !) and thus enables 
blood to traverse the very minutest channels of the body. 

The part which passes to the gall-bladder subserves two 
purposes : (111) the removal, in this form, of a certain portion 
of the effete matter of the body. In so doing it nourishes the 
walls of the gall-bladder. 

_ (iv) a dual function {a) it cleanses the food-residues and 
viscous serous humour from off the walls of the bowel, (b) it 
stimulates the muscles of the (lower) intestine and anus, thereby 
enabling them to perceive when it is necessary to go to stool. 

83. Any obstruction to the flow of bile from the gall- 
bladder through the duct into the intestine is liable to cause colic. 

84. Types of Bilious Humour. 



Group 


Variety. 


No. 


Description. 


Site. 


Origin. 


Quality. 


A 


Normal. 




Clear and pure 


Liver ; blood 


Foam of blood. 


Hot. 


B 


Abnormal 
by ad- 
mixture 
with alien 
substance. 


1 


Citron-yellow 


Liver. 


The alien sub- 
stance is attenu- 
ated serous 
humour 
(added to A). 


Less hot. 




2 


Vitelline-yel- 
low, colour of 
egg yolk. 


Liver. 


Dense (coagulat- 
ed) serous humour 
added to A. 


Less hot. 




3 


Oxidised bile, 
type b. It is 
ruddy-yellow, 
not transpar- 
ent, resembles 
blood, but is 
tenuous. 
Various other 
colours may 
appear in it. 


Liver ; blood 


Simple admixture 
with atrabilious 
humour. 


Less de- 
leterious 
than 4 




4 


Oxidised 
bile, type a. 


Gallbladder. 


Spontaneous 
Oxidation of 
bile = attenuated 
part + ash. But 
this ash does not 
separate out. 


More 

deleterious 
than 3. 



8 4 



THE CANON OF MEDICINE 



Group. 



Variety. 



No. 



Abnormal 
by inter- 
nal change 
of sub- 
stance. 



Description. 



Hepatic form. Liver. 



Site. 



Origin. 



Leekgreen 
bile. 
Gastric type a 



Mildew or 
verdigris 
green bile. 
Gastric type b 



Stomach. 



Stomach. 



Oxidation of at- 
tenuated part of 
blood. The denser 
part of the blood 
separates out as 
atrabilious 
humour. 



Quality. 



Oxidation of 
vitelline bile. 



Mod. 
toxic. 



Less 
toxic. 



Intense degree of 
oxidation of vitel- 
line bile till all 
moisture is lost. 



v. hot, 

extremely 

toxic. 



No. 7 is possibly derived from No. 6 by an increase in the 
degree of oxidation, whereby all the moisture is dried up. 1 he 
fact of becoming too dry accounts for the whitish colour For 
we know that when heatTs applied to a moist substance it firs 
turns black, until all the moisture has vanished, and after that the 
bTaSness changes into whiteness. When the .moisture ils ^ ess 
than half and half, whiteness begins to be visible Th^.^ 
s first charred and finally becomes a white ash. Heat apphed ^ 
a moist body makes it black ; applied to a dry body it makes rt 
wSte. Cold applied to a moist body makes it white, and appUed 
to a dry body makes it black. _ Such is our opinion about the 
Wkp-reen and verdigris-green biles. 

g Verdigris-green form of bile is both hotter and more 
depraved, aid more deadly than all other kinds of bile. It must 
therefore be classed as one of the toxic substances. 



4- 



The Atrabilious Humour. 



85 This is cold and dry in nature. There is a natural 
or normal form of this effete substance, and also an abnormal or 
morbkl form ^^ ^ ^ ^ „ ^ „ ? or sediment of good 

KlooH an effete matter. In taste it is between sweetness and 
bitterness. I arises in the liver and then divides into two 
portTons, one of which enters the blood, and the other goes to 
the ^leen. ^.^ ^^ .^ ^ bl d bserV es two 

™;. {a) Intakes parts in the nourishment of those , mem be 
which need a trace of atrabilious humour to complete their 



THE CANON OF MEDICINE 85 

temperament. Ex.-: the bones, (b) It bestows stamina, strength 
and density and consistence upon the blood. 

88. The portion which passes to the spleen is such as is 
no longer of any use to the blood. Its primary use as regards the 
body as a whole is that it clears the body of so much effete 
matter. ..Its use in regard to one special organ is that it supplies 
nourishment to the spleen. Its secondary use is that by travelling 
to the mouth of the stomach by a sort of milking movement, {a) 
it gives it tone and makes it tighten up and thicken, (b) its 
bitterness irritates (tickles) the mouth of the stomach and sets 
up a sense of hunger and so arouses the appetite. 

89. You must remember that the part of the bilious 
.k\LSfiur which passes to the gall-bladder is something no longer 
needed by the blood, and that the part which emerges from the 
gall-bladder is something no longer needed by that either. It 
is much the same with the atrabilious humour. That part 
which goes to the spleen is such as is no longer needed by the 
blood, and that part which emerges from the spleen is such as is 
no longer needed by the spleen. 

And besides that, just as the bilious humour, in passing 
through the intestine, arouses peristalsis and so helps to get 
food away from the stomach, so the atrabilious humour passing 
from the spleen arouses appetite and leads to the drawing in of 
food down into the stomach. 

Wherefore thanks be to Allah the best Artificer of all 
things, and unending the praise. 

90. The abnormal form of atrabilious humour is not a 
sort of precipitate or " faex " ; it is really a form of oxidized 
material, or ash formed from an oxidation of the commingled 
bilious humour. Thus, when moist things are admixed with 
earthy ones, the earthiness separates out (1) as a sediment. 
This is exemplified in the case of the blood, of which normal 
atrabilious humour is a sediment. (2) as an ash, or oxidation- 
product. In this case the rarefied portion disperses and the 
dense portion remains behind. This is exemplified in the humours, 
of which excrementitious atrabilious humour is the segregate. 

91. _ Blood is the only body-fluid which yields a precipitate 
of this kind. Serous humour does not do so because of its 
viscosity; it behaves like oil. Bilious humour does not do so 
because it is attenuated and is deficient in earthy matters, and it is 
also constantly moving. This is because the blood separates 
out only very little; nothing which needs attention; besides, if a 
substance should separate out, it would soon putrefy or be 



86 THE CANON OF MEDICINE 

expelled from the body. If it putrefied, the attenuated part 
would disperse, and the denser part remain behind. It .is this 
denser unprecipitated part that is the oxidized atrabilious 
humour. 

The abnormal atrabilious humour is hotter and lighter than the 
natural form, and it has in itself a strong penetrative power of moving 
from the upper parts to the lower, and also a destructive action 
(Joannitius). 

92. Excrementitious atrabilious humour is of four kinds : 

(a) the ash derived from bilious humour. This is bitter. The 
difference between this and oxidized bilious humour is that m 
the latter the ash is only admixed, whereas in the other the 
ash separates out after dispersal of the attenuated portion ; 

(b) the ash derived from the oxidation of serous humour. The 
ash becomes salty if the serous humour is too attenuated and 
watery; otherwise the ash is acid or bitter ; (c) the ash derived 
from the oxidation of sanguineous humour. This is salty and 
faintly sweet ; (d) the ash derived from normal atrabilious 
humour. If this humour be attenuated, the ash will be very 
acrid, like vinegar. That is, when vinegar (and the like) is 
sprinkled upon the earth it " boils " and acquires an acrid odour, 
so that flies and insects of all kinds shun it. If the atrabilious 
humour were dense the ash will have less acrimony and be only 

slightly bitter. 

93. There are three kinds of morbid atrabilious humour :■ — ■ 
(i) Oxidised bilious humour, whereby the attenuated portion 
is removed. There are two varieties of this. 

94 Injurious Actions. (2) Sero-atrabilious humour is less 
injurious and acts at a slow rate. (3) Choleric-atrabilious humour 
is more injurious, and undergoes decomposition very readily. 

(a) This form is more amenable to treatment than the other. 

(b) There is another form which is more acrid, and more in- 
jurious. Still, if treatment be begun more early, it will be more 
quickly amenable thereto, (c) A third form effervesces less 
when dropped upon earth and penetrates the tissues less easily, 
and is more slowly destructive. On the other hand it is very 
difficult to disperse, or mature or treat by any remedial measures. 

• These then are the several kinds of normal and excrementi- 
tious humours. 



THE CANON OF MEDICINE 87 

95. Galen regards the blood as the only normal body-fluid, 
for he considers that all others^ are excrementitious and quite use- 
less. But if the blood were the only nourisher of the various 
organs of the body, it would be as much as saying they are all 
alike in temperament and nature. Bone would not be harder 
than flesh were it not for the hardness in the atrabilious humour 
present in the blood.' Brain would not be softer than the flesh 
were it not for the presence in the blood of the soft serous humour 
which nourishes the brain. So we conclude that in the blood 
there are other humours, which leave it (in the various organs). 

96. Moreover, we see how when blood is withdrawn 
into a vessel, it contracts and allows various portions visibly to 
separate out-^foanaj^the yellow bile), ajtm;bicl^aex.(the atra- 
bilious humour), a 2HLlifeS»£gg = 2iii££_j(the' serous humour), 
an . d ajraterjJS^T&e aquosityj, which passes out through the 
urine. One does not count the aquosity among the body-fluids 
because it is not a nutrient, even though it is true it is taken 
in as drink. Its purpose is to dilute the aliment and enable it to 
permeate the tissues. A humour, on the other hand, is a nutrient, 
derived from both food and drink. By the word " nutrient," I 
mean that which is assimilable into the likeness of the human 
body. — a complex substance, and not a " simple " body. Water, 
of course, is a " simple " body. 

* * *- 

97. Some think that strength of body depends on abun- 
dance of blood ; that weakness is associated with paucity of 
blood. But it is not so. It is rather this, that the state of the 
body determines whether the' nutriment will be beneficial to it 
or not. 

Others again, believe that whether the humours be increased 
or lessened in amount, the maintenance of health depends on 
the preservation of a certain quantitative proportion between the 
several humours, one to another, peculiar to the human body. 
But that is not exactly correct. The humours must, besides that, 
maintain a certain constant quantity. It is not a matter of the 
composition of one or other humour, but of (the body) itself ; 
but the proportions which they bear one to another must also be 
preserved. 

98. I purposely omit referring to certain other problems 
relative to the humours, because they pertain to philosophy and 
not to medicine. 

Tentatively to draw up correlations between modern biochemical data and the 
humours as above described would not be quite a useless exercise. From the 
description, it is clear that any given sample of blood contains : (i) all four normal 



88 THE CANON OF MEDICINE 

humours • (2) a certain proportion of immature humours— that is, under-oxidised 
Stive 'products (3) excrementitious humours-the tissue-wastes or effete 
substances 5 th ^by-products of complete oxidation. In diseased states, it- may 
also contain (4) certain depraved humours, including (a) over-oxidised products; 
(h) nutref active substances of various kinds. 
(6) putretactiv ^ ejL ardjafc^M^^^ 

serum-albumen neutrafSt~piS5^ and the salts concerned m maintaining tiieacid- 
base equiHbriSm ; * jabSdaJita bilia^umour : ^ig^e^s choig^ 
and perhaps lecithin " and . v^aMUlite-aadS. I ta^SS&i^gaJuasySffi • neutral 
Shlfrnfes^iCaSQSounas-wnen in colloidal form, ^am.-.mufipads, 
suipnur & glycogen, animal gum, soaps, various salts To (3) . the 

non-J^n-Sli-grlup (urea, ammonta. creatinin, etc.) To (4) : the products 
of bacterial °rowth, various auto-intoxications, diamines, etc. 
° f b To complete the correlations, some idea should be formed as to the: morphol- 
ogical place to which the substances are severally to be assigned, as doubtless the 
humou?s occup7blood-cor P uscles and other particulate components of the blood. 

2. The Mode of Origin of the Fluids of the Body. 

99 Aliment undergoes a certain amount of digestion 
during the act of mastication. The lining of the mouth being 
continuous with that of the stomach, there is as it were one 
continuous digestive surface. When that which has been 
masticated comes in contact with it, a certain change at once 
takes place in it— namely under the influence of the saliva, 
whose action, in virtue of the innate heat within it, is digestive. 
That is how it is that when wheat is masticated it procures the 
maturation of furuncles and abscesses, but has no such effect 
when simply rubbed with water, or even if boiled with water. _ 

Some assert that the sign which shows us that rood _ is 
already beginning to be altered after mastication is that prior 
to this act there is neither odour nor taste in it. 

100. Once the aliment has entered the stomach, true 
digestion goes on— not so much by reason of the heat of the 
stomach as by reason of the heat of the enveloping members— 

namely : 

On the right : the liver. _ . 

On the left : the spleen. This not warm in virtue o f its own 

substance, but in virtue of its blood-supply. 
In front : the omentum, whose fat easily retains heat and 

reflects it on to the stomach. 
Above : the heart, which warms the diaphragm and so 

warms the stomach. 

101 The first stage of digestion yields the essence of the 

aliment, which, in many animals, becomes " chyle "by the help of 

admixture with the fluid which one has consumed. I he chyle 

is of the consistence of a ptisan (broth), that is, as thick as sodden 

^ C 1Q2 The portion of this chyle which is thus diluted is 
drawn from the stomach into the intestines, and then is caused 



THE CANON OF MEDICINE 89 

to enter into the roots of the mesenteric vessels which are found 
all along the intestinal tract. These vessels are slender, and firm. 
Having entered these channels the nutriment passes into the 
portal vein, enters the gateway of the liver, and then travels 
along finer and ever finer divisions until it comes to the capillaries 
(lit., the very fine hair-like channels), which are the ultimate 
sourse of the vena cava emerging from the convexity of the liver. 

The passage of the nutriment through these very narrow 
channels could not take place were it not admixed with water 
consumed in excess of the strict requirements of the body. 

By being distributed over the whole liver in this way, the 
chyle is exposed to the digestive function of the whole organ, 
and the function of the liver is thus accomplished most vigor- 
ously, energetically, and speedily. The change of nutriment into 
blood is now complete. 

103. The various products and by-products of digestion 
up to this point may be tabulated as follows (p) : 

Table of Digestive-products. 

(a) In healthy digestion — 

(i) the blood itself, 
(ii) By-products : 

(a) a foam . . . . . . . . the bilious humour. 

(b) a sort of precipitate the atrabilious humour. 

(b) In unhealthy digestion — 

(iii) By-products : 

(c) An oxidation product, where digestion is carried too far : 

1. Attenuated portion .. .. morbid bilious humour. 

2. Dense portion . . . . morbid atrabilious humour. 

(d) A product when digestion is not 

carried far enough . . . . serous humour. 

104. As long as it stays in the liver, the blood which the 
liver forms is more attenuated than it should be, because the 
wateriness is in excess, for the reason already given. But when 
the blood leaves the liver the excess of water is removed, for it is 
taken to the renal vessels, and so provides the kidneys with the 
quantity and quality of the blood best suited for their nutrition. 
The " fat " of the blood nourishes the kidneys, and the super- 
fluous wateriness and a certain degree of sanguineous material 
passes down to the bladder and so away from the body. 

105. The good blood ascends into the superior vena cava, 
and its subsequent course is into smaller and smaller veins : 
and finally into the finest hair-like channels. Having reached 
these hair-like channels it " sweats out " through their orifices 
and bathes the tissues, according to the decree of Allah. 



9 o THE CANON OF MEDICINE 

106. Table' of the Causes of Humours. 



Name of 
Cause. 


Blood. 


Bilious 
Humour 


1 
Serous 
Humour. 


Atrabilious 
Humour. 


Material 
Cause. 


Those parts of 
the solid and 
fluid aliment 
which are of 
equable tem- 
perament. 


The" attenuated 
hot, sweet, oily 
and sharp by- 
product of ali- 
ment. 


The dense hu- 
mid, viscid, cold 
by-product of 
the aliments. 


The very dense 
by-product of 
the aliments, 
very deficient in 
moisture, and ex- 
ceeding in heat. 


Formal 
Cause. 


Exact and good 
digestion. 


Digestion verg- 
ing on excess. 


Imperfect 
digestion. 


Pre'cipitati ve 
tendency, pre- 
venting the flow 
or dispersal. 


Efficient 
Cause. 


Attempered 
heat. 


Attempered 
heat, for nor- 
mal bilious hu- 
mour ('■ foam '). 
Undue heat, for 
abnormal bili- 
ous humour. 
Site: liver 


Feeble heat. 


Medium heat ; 
i.e., a heat of 
oxidation which 
surpasses the 
limits of equi- 
poise. 


Final 
Cause. 


To nourish the 
body. 


Primary : 

nutrition ; 

attenuation of 

blood. 
Secondary : 
cleansing bowel 
wall ; desire for 
stool (see 82). 


Primary and 
Secondary pur- 
poses named in 
73. 


Primary and 
secondary pur- 
poses named in 
87. 
Nutrition. 
Inspissation of 

blood. 
. Nourishment of 

spleen. 
Tone to stom- 
ach. 
Aid to appe- 
tite. 



107. Further details regarding the efficient causes : 
i. Action of heat and cold. One must not forget that the 
most fundamental agents in the formation of the humours are 
heat and cold. When the heat is equable, blood forms ; 
^hSTheaTis in excess^ bnipus^h^mo^r jorjm; when in great 
excess, so thlToxidation occurs, &hllmm„]m££^$S^ 
When the cold is equable, ser^^Jmrnour^ forjns,,,.; when cold . 
is in excess, so that congelation becomes dominant, atrabilious 

humour forms. . . 

II The faculties. There is also a proportionate relation 
between the active and passive faculties (which has to be con- 
sidered in thinking of the formation of the humours). 

III. The temperaments. One must not get the idea that every 
temperament gives rise to its like and never to its_ opposite. A 
temperament often gives rise to its exact opposite, indirectly 



THE CANON OF MEDICINE 91 

(of course) ; it cannot do so directly. A cold and dry 
temperament may give rise to visible moisture, though this 
would not be beneficial, but would indicate that, the digestion is 
feeble. A person with such a temperament would be thin, with 
supple joints, and hairless skin, cold to the touch, the surface 
veins narrow, and he would be gentle and apprehensive (timid) 
in nature. He would be like the old person, who makes too much 
serous humour and is cold and dry in temperament. 

108. Circumstances which make the atrabilious humour 
■plentiful. 

(1) Immoderate degree of heat in the liver. 

(2) Weakness of the spleen. 

(3) A degree of cold sufficient to be congelative and cause 
marked and long-continued constriction. 

(4) The existence of various long-standing or often repeated 
diseases whereby the humours are reduced to ash. 

When the atrabilious humour is plentiful, it lodges (not 
literally, but virtually) between the liver and stomach, with the 
result that the formation of blood and healthy fluids is interfered 
with, and less blood is formed. 



109. Third digestion. — The blood and that which circulates 
with it undergoes a third digestion in the blood-vessels. 

This is a truth worth noting. The tissue-foods carried by the blood, and the 
tissue wastes discharged into it, undergo treatment within it, which is only efficient 
if certain salts and acid bases are present ; otherwise conversion of such substances 
into available form fails to occur ; and deposition in various tissues, fascia, and 
joints, and even in the vessel-walls (atheroma, e.g.) and nerve-sheaths occur with ill 
effect. These deleterious substances may be thought of as composed of particles 
too large to permeate the (" invisible ") pores of the tissue-boundaries referred to, 
and the pathological condition of " obstructions " which looms so largely in the 
Canon here finds its raison d'etre. 

110. Fourth digestion. When the nutriment has reached 
the various members, giving each its appropriate " element," 
a fourth digestion takes place. 

111. The fate of the residues. The residues from the first 
digestion (namely that in the stomach) — pass out by way of the 
intestines as excrement. Those from the second digestion 
(namely, in the liver)- — pass out chiefly by the urine, though 
some go to the spleen and gall-bladder. The residues from 
the other two digestions are discharged partly by the skin as 
insensible perspiration and external sordes ; partly through 
visible orifices — the nostrils and ears ; partly through the invisible 
orifices scattered over the whole body ; sometimes through 



92 THE CANON OF MEDICINE 

unnatural channels' in the form of inflammatory matter ; some- 
times as appendages like the hair and nails 

If the body-fluids become attenuated, they are readily 
dispersed and discharged from the- body, especially when the 
pores dilate. The loss of such fluids produces great weakness, 
not only by the fact of the loss but also by the dispersion and loss 
of breath which (necessarily) occurs simultaneously 

112 Lastly, it must be clearly understood that not only 
the causes of origin, but also the causes of movement of the 
humours must be taken into consideration. 

Exercise and heating agents set in motion the sanguineous 
humour, the bilious humour, and even the atrabilious humour 
(which is strengthened thereby). Repose sets the serous humour 
in motion and strengthens it. Repose also strengthens some 
kinds of atrabilious humour. 

Even imagination, emotional states and other agents cause, 
the humours to move. Thus, if one were to gaze intently at 
something red, one would cause the sanguineous humour to 
move. That is why one must not let a person suffering from 
nose-bleeding see things of a brilliant red colour. 

" Wer iov, and oassions of a like nature are accompanied 
by a change in the body." (Sum. Theol. 75,3! P- ". trans.) 

The temper of a cow frequently determines the quantity of the 
milk it yields, if it gives milk at all. But under the influence of such 
passions as anger, rage, fury, the milk changes m quality, and 
develops noxious or poisonous properties. Even the flesh may 
become poisonous if the animal suffered intensely or protractedly 
either mentally or physically. Overdriven cattle may thus yield meat 
which contains toxic substances injurious to the human consumer 
(Lindasy, 48 ii. 270, etc.). 

Effects of colours on bodily functions.-^ and yellow are 

injurious to_the eye. ^^}M,^^^S£jmmB^^^^^ 
"wfeTed lighlstlmulaterrr^ Morning light aids nutrition. Colours 
vary in their effect according to their intensity. Conversely, dark- 
ness benefits various conditions ; it helps to induce inactivity and 
sleep (Pereira 152 ; Babbit 151 ). 

Li-ht in another sense has an effect on the emotions : for instance, the light 
of intelligence converts fear (earth element) into caution, affectum (water element) 
into benevolence. 

113 This completes all we propose to say at present about 
the humours and their mode of formation. There are other 
aspects of the subject whose discussion and justification pertain 
to the philosopher. 

(See also the composite Chart at the end of the Volume.) 



r 




THESIS V. THE MEMBERS 

i. What- a Member is and what are its Components 

114. The members of the body are derived primarily 
from the commingling of the humours, just as the humours are 
derived primarily from the commingling of the aliments, and 
the aliments are primarily composed of commingled " elements " 

115 There are simple members and compound members 
I he simple members are those whose structure is homogeneous 
throughout, so that their name describes them in all parts • 
e.g. flesh,_ bone, nerves, and the like* The compound members 
are those m which one and the same word is not a correct descrip- 
tion of all the parts. For instance, in the case of" hand " " face " 

"v? T" ^ e ^ iS u n0t " faCG " ; a P art of the h ^ d is not 
hand. Ihese members are called " instrumental " because 

they are the instruments whereby the passions and actions of 
the mind ( soul ") are achieved. 



Table of the Members. 



Auxiliary Organ 
Afferent 



Principal 
Organ 



Sense Organs Lung 



Immediate 

Auxiliary Organ 

Efferent 



Remote 
Auxiliary. Organ 
(Elementary 

Tissues) 



V 

BRAIN 

(Animal 
breath) 



V 

Nerves 



V 
HEART 

(Vital 
breath) 



V 

Arteries 



Stomach 

AND 

Intestine 
Veins 

LIVER 

(Natural 
breath) 



Constituents of 
Humours 



V 
REPRODUCT- 
IVE GLAND 



V v 

Gall-bladder, Ducts and 

Spleen, Kidney Genital Adnexa 



V v 

Bones, Cartilages, "\ 
Ligaments, Muscles, I " Flesh 
Fasciae, Tendons, | Fat 
Membranes I 



V 

Intestinal 
Tract 



parts. 



Equivalent to the modern term Element, 

93 



ary tissues. Cf. " homoi 



lomenous ' 



94 THE CANON OF MEDICINE 

116. The Simple Members (the " elementary tissues.") 
"Simple": Cf. the' scholastic sense— homogeneous ; in- 
divisible. (See § 19.) 

i . The bone. This is sufficiently hard to form the founda- 
tion of the body as a whole, and provide the purchase needed for 

its movements. 

2. The cartilage. Being softer than bone, this can be bent, 
and yet it is harder than all the other members. It was made for 
the purpose of providing a cushion between the hard bone and 
the soft members, so that the latter should not be injured when 
exposed to a blow or fall, or compression. This is shown m the 
case of the shoulder-blade and the bones over the praecordia, 
and the ribs ; and in the case of the epiglottis and xiphisternum. 
In the case of joints, it prevents the tissues from being torn by 
the hard bone. It gives a purchase for a muscle to obtain ex- 
tension in places where there is no bone to give attachment or 
support (for instance the muscles of the eyelids), and also gives 
attachment to muscles without being too hard for them (for • 
instance, the epiglottis). _ . 

3. The nerves. These are structures arising from the brain 
or spinal cord. They are white, soft, pliant, difficult to tear, and 
were created to subserve (a) sensation, (b) movement of the 

limbs. . . 

4. The tendons. These form the terminations of the 
muscles. They resemble nerves in appearance. They are 
attached to movable members, and when the muscles contract 
and relax, the parts to which the tendons are attached move to and 
fro. "They may sometimes broaden when the muscle expands, 
and then become narrow again on their own account, lengthening 
and shortening apart from the lengthening and shortening of the 
muscle. Sometimes this is through the intervention of ligaments. 
The upper part of the muscle is called " flesh " ; that which 
"leaves the flesh and passes to the joint, bringing the two close 
together, is the " tendon." 

5. The ligaments. These structures have the appearance 
and feel of nerves. They are of two kinds : true and false. The 
latter extends to the muscle. The former does not reach as far 
as the muscle, but simply joins the two ends of the bones of a 
joint firmly together. This false ligament has not the feel of 
ligament, and is not painful when moved or rubbed. The 
auxiliaries of the ligaments are the structures attached to them, 
as has been explained. 



"IT 



THE CANON OF MEDICINE 95 

6. The arteries. These structures arise from the heart. 
They are hollow, elongated,, fibrous, and of ligamentous con- 
sistence. _ Their movements consist in expansion and contrac- 
tion, which distinguishes them from the veins. They were 
created in order to enable the heart to be ventilated, fuliginous 
vapour to be expelled therefrom, and the breath* distributed 
by their means to all-parts of the body. 

7-_ The veins. These resemble arteries except in so far as 
they arise from the liver and do not pulsate. Their purpose is 
to carry the blood away from all parts of the body. 

«,* Jit 3 /* 16 *+? ftf^ wTl^T^ r6ad " t0 a11 P arts of the bod y-" As we know, 
the belief was that blood left the heart to all parts of the body, and also left through 
the veins to all parts of the body. The arteries carried the breath. The veins 
earned the aliment. The heart therefore drove blood away from it on both sides 
the distribution into minute capillaries was known for both series of vessels But it 
did not seem to occur that the two flows were in opposite directions, and that as much 
went out of the heart as came into it. The conviction that the two quantities were not 
ITt + T aS f real r eason f ? r n °t going on to the truth of the literal circulation 
At bottom, it was the equality of the two quantities which Harvey had to prove 
in order to establish the fact of the circulation.) P 

8. The membranes. These structures are formed of 
extremely minute interwoven filaments which are extremely 
delicate. Their object is {a) to form the external covering for 
other structures and thereby (b) preserve the form and outline 
of these structures, (c) to support the members, (d) by means of 
their fibres to bind together the nerves and ligaments with the 
members ; for instance they hold the kidneys in position, (e) to 
impart sensation to members which are themselves insensitive, 
since by providing a sensitive covering they enable the member 
to be aware of anything befalling it. For instance : the lung, 
the liver, the spleen, the kidney ; all of which are in themselves 
insensitive^atjdjg^^ werTtHare not a 

^Hl e SbBae,oyerJ:hjm,t_ A flatulent distension or an inflammatory 
deposit in the organ is felt by us only because the enclosing 
membrane, being stretched, feels it ; or, in the case of an 
inflammatory mass, is aware of the weight. 

9. The flesh. " Flesh " includes muscles, fasciae, tendons, 
ligaments, connective-tissues, and so forth all together. Flesh 
is that_ which fills up the spaces left within the members, thus 
imparting firmness and solidity. 

117. In every member there is a natural faculty (the 
vegetative faculty) which subserves its own- nutrition. This 

* Nowadays we would say " oxygen *' instead of " breath " 
their ^erfton^TcovelS ("" ***** "* ^ ^^ to ' tou <* *** ^ ™ 



9 6 THE CANON OF MEDICINE 

faculty is the power by which attraction, retention, assimilation, 
union with nutriment, and expulsion of effete matter are secured. 
Members may therefore be classified accordingly. But besides 
that, some members possess a further faculty which passes from 
them to another member, while others have not sucha faculty. 
Other.. members again have still another faculty which passes 
into them from another member, and some have not such another 

faculty. 

The following associations may therefore be assumed : — 
(a) receiving and also giving a faculty. 
{b) giving and not receiving. a faculty. 

(c) receiving and not giving a faculty. 

(d) neither giving nor receiving a faculty. 

118. There can be no doubt about the existence of the 
first-named. All agree that the brain and the liver each receive 
their power of life, natural heat, and breath from the heart, and 
that each of them is also the starting-point of another faculty 
which it sends out to other organs. But there is a disagreement 
about the second. Thus in the relation betweenthe brain and 
sensation, is sensation confined to the (literal) brain, ornot ?_ In 
the relation between the faculty of nutrition and the liver, is it 
integral in the liver, or not ? 

119. Then, too, in regard to the heart. There is a great 
disagreement between the philosophers and the physicians. The 
great Philosopher said that the heart is a member which gives 
and does not receive ; that it is the first root of all the faculties 
and gives the faculties of nutrition, life, apprehension, movement, 
to the several other members, — whereas physicians (and some 
of the ancients) considered these faculties to be distributed among 
several members (the faculty of nutrition in the liver ; of vital 
power in the heart ; the mental faculties in the brain) ; and that 
hence there can be no such thing as a member giving without 
receiving. However plausible the physicians are, careful con- 
sideration shows that the argument of the Philosopher is much 
nearer the truth. 

" There are the minds of the cells of the liver, and the liver-mind— the mind 
that regulates the activities of the liver-cells. Above the liver-mmd and above 
the stomach-mind and the heart-mind is the general physical mind ; and, above that 
general physical mind, and also above the intellectual mind is a higher mind still. 
There is a hierarchy and kingdom within us." — (Miles, 135 , p. 92). 

120„ As to the third association, we consider that there 
can be no doubt about the fact that some members receive and 
do not give. Thus, the flesh receives the power of sensation and 
life, but has not the power of imparting another faculty in return. 



THE CANON OF MEDICINE 97 

121. As to the fourth — there is also a disagreement both 
among physicians and among philosophers. On the one hand 
it is thought that the non-sentient bone and flesh and the like 
could not continue to live unless these powers were residing in 
them, and that therefore they do not need to receive ; — that the 
power provided by the aliments conveyed to them is adequate, 
and that therefore they neither furnish a power for another 
member nor does another member furnish them with a power. 
The opposite opinion is that the powers in those members are 
not residing in them, but are formed in the liver and heart ; 
and when they reach these members, they come to rest within 
them. There is no means of deciding between the two views 
by argument but the inability to do so is no hindrance in practice. 
As to the first of these two views, one must realize that it does 
not matter whether the heart be the source of sensation and volun- 
tary motion in the brain, or not ; whether the source of the 
nutritive faculty be in the liver, or not. It is of no significance 
whether the brain has in itself the source of the powers of the 
soul, or whether these powers only come by way of the heart. 
In any case it is only a relation. If the liver is the starting-point 
of the nutritive faculty, that too is only in relation to other 
members. 

Then as to the second of the two views, one must realize 
that it does not matter whether the natural faculty in a member 
like bone is innate in it in virtue of its temperament, or whether 
it arose in the liver first, or whether neither is true. One must ■ 
rather realize that the faculty could not be there at all were it 
not for the liver, and that therefore if the path were obstructed 
the bone would cease to receive the necessary nutriment, and 
its functions would cease — exactly as holds in the case of move- 
ment when some nerve-connection with the brain is severed. 
There is the natural faculty in the bone as long as its tempera- 
ment is maintained. 

122. The whole discrepancy is removed by regarding 
some members as principal or vital, some as auxiliary, and some 
as neither vital nor auxiliary. 

123. Classification of Members into Principal (or, Vital) 
and Auxiliary. 

The principal (or, vital) organs are those in which the 
primary faculties of the body arise- — i.e. the faculties necessary 
either to the life of the individual or to the life of the race. 

" In thej body is a part which being sound the rest is sound, and which being 
unsound, the rest is unsound. And this is the heart." (Burton : Night 80). 

H 



9 8 THE CANON OF MEDICINE 

The principal organs necessary for the life of the individual 

are three in number : . . . , 

'i—The heart, the source or starting-point ot the vital 

power, or innate heat. , „ , • .- a 

Y 2 __The brain, the seat of the mental faculties, sensation and 

movement. . . . c u - 

3 — The /iw, the seat of the nutritive or vegetative faculties. 

The organs concerned in the maintenance of the life ot the 
race are : the three just named, and : 

,__The generative organs, some of which are essential and 
others auxiliary. The essential, function is that of forming 
generative elements ; the auxiliary functions are those ot 
giving the masculine and feminine form and temperament. 
These functions are inseparable from the race, and yet play no 
part in the essence of life. _ 

The aa^/wry members are of two kinds : (a) preparative, 
(^ purely or absolutely auxiliary. The former come into 
operation before the principal members can come into play. 
The purely auxiliary members come into operation after the 
principal members have functioned. This is conveniently shown 
in the following table : 



Preparative member. 

Lung. 

Stomach. 

Liver, with other nutri- 
ent members and the 
guardians of the 
breath. 



Testis or ovary. 



Member subserved. 



Heart. 



Liver. 



Auxiliary member. 



Aorta. 



Brain. 



Generative organs. 



Veins. 



Nerves. 



Penis and erectile tis- 
sues (and ducts.) 

Female organs car- 
rying the semen to 
the site of concep- 
tion. Uterus as per- 
fector of the virtue 
of the semen. 



* These are the " adnexa. 



THE CANON OF MEDICINE 99 

124. Classification of the members according to action.-— 
Galen classified the members into those which effect an action 
(e.g. heart), those which assist the action (e.g. lung) and those 
which achieve both (e.g. liver). But for my part, I consider as 
" action " that particular kind of action by means of which a given 
member accomplishes the maintenance of the person's life or 
the perpetuation of the species. Thus, the heart gives rise to 
the breath. Action is assisted when one member is prepared 
for receiving the action of the other member, thereby completing 
the process either of giving life to the individual, or of propagating 
the race. Thus, the lung prepares the air. The liver carries out 
the first digestion so far as to prepare for the third and fourth 
digestion. The more perfectly the liver functions in regard to 
the second digestion, the more likely is the blood so made to 
be adequate for nourishing the tissues. Hence in this respect 
the liver effects an action ; and, in so far as the liver assists in ac- 
complishing a further action, so it is preparative for that action. 

125. Classification of the members according to their origin. — 
Some members take their origin from the semen : namely, 

members composed of like parts, except the flesh and the fat. 
Other members come from the blood : namely the flesh, and the 
fat. Other members come from both male and female "sperm."* 
According to the teaching of philosophy, the process of genera- 
tion may be compared with the processes which take place in the 
manufacture of cheese. Thus the male " sperm " is equivalent 
to the clotting agent of milk, and the female " sperm " is equiva- 
lent to the coagulum of milk. The starting point of the clotting 
is in the rennet ; so the starting-point of the clot " man " is in 
the male semen (" We made the life-germ a clot "■ — Q.23.14). 
Just as the beginning of the clotting is in the milk, so the begin- 
ning of the clotting of the form of man lies in the female " sperm." 
Then, just as each of the two — the rennet and the milk. — enter 
into the " substance " of the cheese which results, so each of the 
two — male and female sperm — enters into the " substance " 
of the " embryo." 

* The word " Sperma " is here really more exact than " semen." 
Semen = x + sperm. Therefore it is not incorrect to speak of a " female sperm." 
Note that only a portion of the spermatozoon enters into the new human being, 
and not all the ovum. 

Paracelsus wrote that the " sperm " is not the visible seminal fluid of man, 
but rather a semi-material principle contained therein, or an " aura seminalis," 
to which, the semen serves as a vehicle (De generatio hominis : Hartmann, «, p. 72). 
In another place he says " the matrix attracts the seed of both persons, mixed with 
the semen, and afterwards expels the semen, but retains the sperm. Thus the 
seed comes into the matrix. The matrix does not merely mean the womb of a 
woman ; the whole body of the woman is a mother, a matrix." — (De morbo. matric). 



ioo THE CANON OF MEDICINE 

Galen gives a contrary account. He considers that each of 
the sperms has both a coagulative power and a receptive capacity 
for coagulation ; so he says that the coagulative power is stronger 
in the male than it is in the female, but the receptive capacity 
for coagulation is stronger in the female than the male. 

But the real truth of the matter is expounded in our own 
works dealing with the fundamental principles of natural science. 

126. Relations between the jemale menstrual blood and the 
embryo. 

i. During pregnancy, the blood which is otherwise dis- 
charged from the female at the time of menstruation becomes 
nutriment (for the embryo) in three ways. One portion is 
changed into the likeness of the substance of the sperm and the 
members derived therefrom. This is the nutriment which 
enables growth to take place. Another portion is not nutriment 
of that kind, but is capable of being aggregated into the material 
which fills up the interstices in the principal members and 
becomes flesh and fat. 

A third portion is effete material, and not utilizable for 
either of the two preceding purposes. It remains in the same 
situation until the time of birth, and is then expelled with the 

infant. 

After birth, the blood which the liver of the infant makes 
takes the place of the maternal blood. So it arises from an organ 
which itself was formed out of the maternal blood. 

127. The flesh of the infant is derived from the gross 
blood, congealed by heat and dryness [cf. the fact that a moderate 
degree of heat coagulates' egg-white]. The fat of the infant is 
derived from the aquosity and unctuosity of the blood, which 
cold has congealed and heat dispersed. 

128. Repair of damaged members. — {a) Members derived 
from the sperm. 

Should a loss of continuity arise in the members derived 
from the sperm, restoration can only occur, and then only in a few 
of them, and if the individual is spare in habit, and has not passed 
the age of juvenility. These members are : the bones, the small 
branches of veins ; medium-sized veins and arteries. For when 
disseverance occurs in such members as bone and nerves, they 
will not grow again. 

(b) Members derived from the blood. 

If the members which are derived from the blood are 
damaged, they are renewed out of like substance. E.g. the flesh. 

(c) Members derived from both blood and sperm. 



THE CANON OF MEDICINE 101 

If the member which is damaged arises both from blood 
and sperm, then, as it is not very long since the sperm was there, 
it will be reconstructed (Ex.; the teeth at the age of juvenility) 
unless meanwhile the blood has undergone a change of tempera- 
ment. In that case re-construction would not take place. 

129. Sensation and movement is sometimes conveyed to a 
member through one single nerve, sometimes through several 
nerves. In each case the nerve is the source of the power. 

130. The membranes which cover the internal organs. ■ 

These all arise either from the pleura or the peritoneum. Those 
members in the thorax, which derive their covering from the 
pleura, are : the diaphragm, the veins and arteries ; the lung. 
These organs in the abdomen are covered from the peritoneum 
which covers the muscles of the abdominal wall. 

" • * ' * r 

131. Texture of members. All members are either fleshy 
in texture or fibrous (like the flesh found throughout muscles), 
or are devoid of fibrous texture (e.g. liver). Fibrous texture 
goes with power of movement. — voluntary in the case of voluntary 
muscles ; involuntary in the case of the uterus and veins. Com- 
pound movements, like that of deglution, depend on the direction 
of the fibres being various. — longitudinal, oblique, transverse. 
The longitudinal fibres produce in-drawing ; the oblique fibres 
expel or force onwards ; the transverse fibres grip and hold. 

Even where a member has only one coat, as is true in the 
veins and bladder, there are still three kinds of fibres which inter- 
weave one with another. Members which have two coats have 
the cross fibres externally, and the others on the inner side. 
The longitudinal fibres tend towards the inner surface. The 
purpose of this arrangement is that in-drawing and expulsion 
should not occur simultaneously, whereas there is no objection 
to the acts of in-drawing and holding and gripping occurring 
together— except in the case of the intestines, where much 
retention is disadvantageous, whereas in-drawing and expulsion 
are all-important. 

132. Hollow (tubular) members which contain substances 
different from their walls have sometimes one coat, sometimes 
two. The presence of two coats serves the following purposes : 

(i) to provide the necessary strength to the Walls, so that 
there is no risk of the proper power of movement failing at any 
time. Ex.: arteries. 



io2 THE CANON OF MEDICINE 

(2) to ensure that the contents shall not dissipate or escape. 
One coat would, not suffice to retain so tenuous a substance 
as the breath which the arteries contain ; and it would make the 
risk of rupture or severance in injuries too great, m which case 
death would be very liable to occur because the blood would then 
drain out.* This is a very great danger. 

(3) where there is a demand for vigorous suction and ex- 
pulsion, it is beneficial to have a separate instrument available 
for the performance of both actions rather than to distribute both 
powers over the one coat. This applies in the case of the stomach 
and intestines. 

(4) where each coat of a member subserves its own action ; 
or each action requires its own particular temperament. Thus, 
in the case of the stomach, there is a need of a power of sensation 
(which can only exist in a tissue containing nerves) and also a 
power to execute the movements of digestion (for which a fleshy 
tissue is needed). Hence each need is supplied by its own coat— 
the nerve-containing tissue for the power of sensation ; the 
fleshy coat for the power of executing the movements entailed 
in the work of digestion. Nature made the inner coat capable of 
sensation, and the outer coat fleshy. The operation of sensation 
requires actual contact with the nervous tissue, as is true m the 
case of the sense of touch ; but the movements necessary to enable 
digestion do not require contact of the material to be digested 
with the fleshy walls. 

133. Certain members (e. g. the flesh) have a temperament 
so near to that of blood that the latter needs to undergo little 
change in order to subserve nutrition. Consequently there is 
no need for apertures or for spaces or cavities in these members, 
wherein to retain nutrient material pending its transformation 
into their own substance. In such members the nutrient at once 
becomes identical with their substance. 

134. But other members (e.g. the bones) have a tempera- 
ment which is very different from that of the blood. Therefore 
before these can be nourished, the blood must needs undergo a 
series of successive transformations before becoming like tothem 
in substance. That is why spaces were made in which nutriment 
can be retained long enough to enable the conversion to take 
place. This is true in the case of the femur and humerus. In the 
case of the lower jaw bone numerous apertures are seen scattered 
through it. In this way more nutriment can be accommodated 

* Note this proof that Avicenna knew the arteries contain blood. 



THE CANON OF MEDICINE 103 

than is necessary for the moment, and the transformation into 
their own likeness can take place little by little. 

135. Lastly, strong members expel their waste matters 
into the adjacent weaker members. Thus the heart to the axilla ; 
the brain to the tissues behind the ears ; the liver to the groins. 



§ i_i8. The next four subsections of the text are omitted. They 
deal with the anatomy of the bones, muscles, nerves and blood- 
vessels, and are naturally inadequate in comparison with modern 
Anatomy. 

Ancient anatomy has been criticized for allowing as a basis the dissections', 
of monkeys and other animals, apparently overlooking the important factor of 
circumstance, m order to give the impression of lack of acumen in those days But 
in our days, ability and acumen being taken for granted, it is considered allowable 
to base conclusions m the domain of physiology and pathology upon laboratory 
reactions obtained from the same kinds of animals. Some workers are alive to the 
possible insufficiency of data so obtained, but make a virtue of necessity This 
may also be claimed for Avicenna. 

Avicenna was seeking to express a certain truth in these sub- 
sections as well as in other parts of the Canon, and it is profitable 
to abstract it and develop it further in the light of modern knowledge. 
The following are some of the considerations in mind. 

§119. The variations of anatomical structure which are 
observed throughout the animal kingdom are the expression of the 
differing nature and requirements of the respective animal-types. 
But in dealing with comparative anatomy it is usual to regard 
evolution as the essential factor, and a false meaning to the phenomena 
is thereby instilled. We speak of animals as " higher " and " lower " 
for convenience, but strictly all are equal, because " each creature 
has such perfection as it was possible for it to have." (St. Thomas, 82 
p. 108), and its place is in accordance with the " end " for which it was 
brought into being, the word " end " bearing the scholastic sense. 
The proper use of the theory of evolution in comparative anatomy, like 
that of Ehrhch's theory in regard to immunity, is that it enables 
many discrete facts to be memorized. To raise either to the dignity 
of truth " necessitates an overlooking of the fundamental properties 
of the nature of being. 



120. 



Deformities. These may be explained on an evolution- 
ary basis, using the ideas of " reversion," " atavism," etc. When the 
individual is studied in regard to his " end " (in the scholastic sense) 
a different conception comes to light. But as this brings in the 
question of events belonging to the category of morals (" to the third 
and fourth generation "), the problem is at once evaded. Such a 
conception would not be vitiated by the existence of deformities 
among animals. 



121. 



- The intimate structure of the body is always changing 

although the anatomical structures appear to remain unchanged. 



io 4 THE CANON OF MEDICINE 

Hence it is possible to see in these structures' merely a locus for the 
various faculties and functions pertaining to the physical, mental 
and emotional life of the individual. Compared with his existence 
in the scheme of things, the anatomical details are mere " moments 
musicales." 

To take a special example,, one might regard the blood-forming centres as the 
(momentary) point of meeting of two vitalities. (Cf. §147.) 

§ 122. Relation between structure and function. This formed 
the subject of a classic in medical literature — that in which Galen 
regards' anatomy as the expression of the 4>va-i,s. Such a teleo- 
logical view is not in favour to-day, and, indeed mistakes (as 
Galen did) the root principle emphasized in these pages. To use the 
symbolism given in § 56, 64, M is not the " expression " of F. In 
associating structure with function this must always be remembered. 
The examples available for Avicenna, striking as they seemed to 
him, are surpassed by those possible through modern knowledge. 
Thus, harmonious succession of events, both in time and place, is to be 
discerned throughout the body. The output of the various digestive 
juices, separately achieved, yet co-ordinated as to time is also 
co-ordinated as to place. The output of bile, for instance, is fitful— 
sometimes a delicate trickle, sometimes in spurts, sometimes m larger 
quantities ; and this in co-ordination with the activity of the muscular 
bundles beneath the membranes which secrete the digestive fluids— 
in which both nervous and vascular variations play an intimate part. 
Out of many other instances, the following may be given. The- 
adrenal vein joins the inferior vena cava at a given point, in order to 
secure that the adrenal secretion shall enter the blood in time to 
receive the activating substances supplied for it by the liver before 
it becomes exposed to the oxygen contributed by the respiration ; 
for otherwise the activation would be nullified. (Cf. Sajous 149 .) 

§ 123. Transcendence of organs, fluids, and the like, beyond 
anatomical boundaries. — This has already been referred to in the 
opening chapter. Thus (a) "heart" includes the arterial system 
and something more; "liver" includes the venous system and 
something more ; " brain " similarly goes beyond the organ within 
the cranium to the cutaneous nerve-endings. This is why a " function 
test " for a given organ is never satisfactory, (b) Vascular channels 
and tissue spaces are simply demarcations of fluids from adjoining 
tissues. The river exists because there is water to flow, and in- 
cidentally is an " anatomical feature " of the country,serving various 
purposes. Its presence is the indication of, and continues only as 
long as, certain incessant changes occur in Nature at large. To use 
other words, the vascular channels are the materialization of the 
stream of blood ; or, the current of " life " made the blood-vessels 
become demarcated. (c) The humours of the body circulate also in 
the subtle fashion suggested thus : the sanguineous humour is not 
only in the blood vessels but also in lymph channels _: the serous 
humour moves in the connective-tissue spaces as well as in anatomical 
lymphatics, and appears also in the form of the " eau de constitution " 



THE CANON OF MEDICINE 105 

(Vallery-Radot 141 ) of ■ the tissues : the bilious humour may be 
followed in the track of cholesterin (and other constituents.) The 
constant loss of hair, nails, teeth, should also be recognized as being 
part of the constant separation of " superfluities." (Cf. Paracelsus 29 ). 
(d) If we realize that tissue-spaces and cavernous tissues are forms of 
channels, it will be clear that the whole body is really an aggregate 
of " tubes .'.' of some sort. It may then be said further, that disease 
always starts from tubes, — namely when their lumina are blocked or 
when their " walls " become semipermeable or quite impervious. 

§ 124. Anatomical structures depend for their existence on 
chemical structure. Water, for instance, may be said to come into 
visibility in the form of an anatomical structure. Conversely, other 
substances are only visible as long as they are not yet an integral part 
of the living substance of the body, and others are visible because 
they have ceased to be such. 

As soon as microscopic visibility is attained, the visible thing 
has ceased to be " living." Stability of form entails the stagnation 
of certain substances, and also implies that they have been rejected 
from the cycle of life in order to provide the substrate or platform or 
points d'appui for the actual living substance (i.e., the life-principle) to 
manifest its faculties during a certain (often limited) period of time. 
Cf. § 121. 

§ 125. Histology (i.e. microscopic anatomy) and function. 
From the preceding consideration, when a tissue is observed through 
the miscroscope, the thought should be " that is the spot where this 
or that substance has emerged into visibility at this moment." This 
conception is specially applicable to the case of the blood-cells. 

Cf. § 95-99- 

§ 126. Anatomy as the expression of strengths and weaknesses. 
It is clear that the relative development of different parts of the body, 
from head to foot, reveals its physical strengths and weaknesses. 
Where one part is strong, another is compensatorily weak. But it is 
less obvious, and less realized, that anatomical conformations are also 
revelations of strengths and weaknesses of mental make-up. Here 
also, the strength of one feature goes with deficiency of some other. 
The root principle of jelal and jemal already referred to (§ 82) holds 
good throughout, and in a multitude of directions. Mental 
capacities and activities affect the vegetative processes just as do the 
emotions, for their influence lasts throughout life. As S. Thomas 
says : (a) " every operation of the sensitive soul belongs to the 
composite " (S.T., 75, 3, 84 p. 10). (b) " There are certain operations 
common to the soul and the body, such as fear, anger, sensation, and 
so forth ; for these happen by reason of a certain transmutation in a 
determinate part of the body, which proves that they are operations 
of the soul and body together " (C.G., ii. 57, 82 p. 139). (/) " We 
find in the intellective appetite, which is the will, operations specifi- 
cally similar to those of the sensitive appetite, differing in this, that in 
the sensitive appetite they are passions, on account of its connection 
with a bodily organ, whereas in the intellective appetite they are pure 
operations. For just as by the passion of fear which, in the sensitive 



io6 THE CANON OF MEDICINE 

appetite, one shuns a future evil, so without passion, the intellective 
apoetite has a like operation " (ib., 82 90, p. 190). 

" § 127. From all this it is clear that much is to be learned from 
external anatomy (head, face, hands, joints, skin markings, etc.) as 
to the strength and weakness, not only of the body as a whole, but of 
the several organs in particular. Were the study of internal anatomy 
combined with the external, the associations would be more appre- 
ciated. The "case" is not really finished when a "handful" of 
viscera has been studied in the autopsy-room or even in the labora- 
tories attached thereto. The remaining "shell" passes on into 
oblivion bearing its wonderful secrets with it, for its language is such 
that however loudly it " speak," there are few with ears to hear, and 
perhaps none with ability to interpret. 



THESIS VI 
The Faculties of the Body 

.„ " LlFE appears through various operations in different degrees of living things " 
(S. Thomas, S. Th. q. 76, art. 1). ■ 06 

1. General Discourse about the Several Kinds of Faculty 



gl^' ACULTIES (136) are to be distinguished from 

^ zj functions. The difference is that the former 

originate the latter. But as each function depends 

on its own special faculty they can be treated together. 



Faculty : the name of a property whereby the phenomenon of life is mani- 
fested. Function : actualized potentiality. 

Faculty =power =potentiality. Faculty is not force ; it i s potential power ; it 
is static. Power is the faculty in a state of activity ; it is dynamic. 

The tout ensemble of faculties is " the soul." 

The tout ensemble of functions is " life." See § 150. 

Weakness of faculty corresponds to " hypof unction." Plethora of faculty 
corresponds to " hyperfunction ". 

137. There are three kinds of faculty, and therefore of 
functions proceeding therefrom. Namely, the vital (haywaniat) ; 
the natural [taby 'yat) and the animal (nafsaniat). 



§ 128. These three terms, derived from the Latin version, only 
properly express the meaning of the Arabic if they are taken in 
their original sense. The third term is rendered " psvchical " by 
some translators, 163 but is open to objection because' its modern 
usage does not sufficiently correspond to the idea of nafsaniat. 

Other words are preferred in the course of the present trans- 
lation. The familiar " vitality " is convenient for the first term. 
The words " vegetative " and " sensitive," employed in the 
Dominican translation of the Summa, 8 * are satisfactory renderings 
for the other two terms, and are to be understood strictly in the 
Thomistic sense. The term "natural" is reverted to in 551 for 
reasons there given. 

The variations in scope exhibited by these and allied terms are 
conveniently indicated in the following table. 

107 



io8 



THE CANON OF MEDICINE 



§ 129. Analysis of certain Terms applied to living things : — i.e., Beings 

ENDOWED WITH " LlFE." 







A. 


B. 


C. 






Vegetable. 


Animal. 


Human. 


I. Distinctive 










quality. • 
1 . In Modern 


. 


Vegetative. 


Sentient. 


Rational ; intellec- 


language. 




Organic. 


(Lower) mental 


tual, Higher men- 






powers . 


tal life, Psychic 






Organo- vegetative 




powers. 






(Martinet) 






2. Platonic term. 




Nutritive. 


Appetitive. 


Rational. 


3. In Avicenna. 5 


Vital.' 


Natural. ' 


Animal. 5 


Ratiocinative 








faculty. 


4. Scholastic 




Vegetative (life or 


Sensitive "(life or 


Rational (life or 


terms. 




soul). 


soul). 
Sensuous 
(Necessarily im- 
plies " appeti- 
tion," 84 78, i. p. 78) 


soul). 


II. These terms are 










based on — 










.(a) the faculties 










pertaining to each 
(i) Pre-modern 




Plants have only 


Animals have also 


Human beings have 


thought. 




nutrition, growth, 


sensation and 


also intellect or 




and reproduction. 


movement. 


intelligence. 


(ii) Modern 




But modern re- 


But some animals 


But this is not so 


thought. 




search (cinemato- 


exhibit intellec- 


for some races of 






graph, etc.) shows 


tual powers often 


men, and in some 






sensory and mo- 


supposed to be 


cases of disease of 






tor powers. 


purely human.' 


the brain. 


(iii) In terms of 




Unconscious life. 


Subconscious life 


Fully conscious life 


Consciousness. 






and lower con- 
scious life. 




(6) On essential 
manifestations 


As 


As " nature." 


As sensation.move- 


As capacity for ab- 


" breath"' 




ment, and cogita- 


stract concepts. 


(3. Avicenna). 






tive power.' 




(c) On fundamen- 




Effected by means 


Effected by means 


Is effected apart 


tal causes. 




of a corporeal 


of a corporeal or- 


from a corporeal 


(4. Scholastic 




organ, in virtue of 


gan, but not in 


organ or quality. 


basis.) 




a corporeal qual- 
ity. 


virtue of a qual- 
ity. 
Deals with parti- 
culars. 


Deals with univer- 
sal 81 (78, i. p. 


(d) on theological 
considerations. 








78). 




Mortal. 


Mortal. 


Immortal : {a) ab- 










solutely (Scholas- 










tic view) ; (6) con- 










ditionally (some 










creeds). 


III. Chief organ 
concerned. 
1. In modern 












All vegetative - or- 


Nervous system 


Brain (Grey matter 


thought. 




gans equally im- 
portant (Bio- 
chemical process- 
es in general). 


(automatic and 
central) . 


of cortex.) 


2. Platonic. 




Liver. 


Heart.' 


Brain. 


3. Avicenna. 


Heart. 8 


Liver (and Gonads) 


Brain. 




4. Scholastic. 




All viscera. ' 


Nervous system, 


No material organ. 




No special organ 


but also the whole 








because " life " 


" being." 








belongs to all. 







THE CANON OF MEDICINE ic 9 

Notes on points arising out of this table : 

1 Boundaries of the Three Kingdoms : — These are admirably set out in Chahar 
Maqala 7 : "When the vegetable kingdom was produced, God' gave it the four forces 
and the three faculties. When the animal kingdom was produced, God added 
two more faculties— that of perception (with five external senses and five internal 
senses), and of movement. When the human kingdom was produced, God added 
a capacity for abstract concepts (intelligence)." 

2 Ayicenna's division : this is determined by medical requirements. 

3 Vital faculty. — This is not specifically mentioned bv S. Thomas, because 
implied in the word " life." He refers to it thus : " The vital operation . 
whereby something is shown to be living " 84 (liv. 2. p. 44). " Life-principle " has 
a wider scope than implied in " vital faculty " : — " The vital principle is the ' form ' 
or determining principle of the living being. Coalescing with the material factor it 
constitutes the living being. It unifies the material elements into one individual. 
It holds them together ... as a mass of chemical compounds, many of them 
most complex and in very unstable equilibrium, constantly undergoing change and 
tending to dissolution into simpler and more stable compounds. W ; hen life ceases, 
the process of disintegration sets in with' great rapidity. The function, then, of 
this active informing principle is that of a unifying, conserving, restraining char- 
acter, holding back, as it were, and sustaining the potential energies of the organism 
in their unstable condition." — (Maher 17 , p. 427). 

1 Natural faculty.— i.e., " pertaining to the .' nature.' That is, (a) the mere 
fact of living at all, (b) powers in common with laws of Nature in general. Compare 
the term "natural science," " natural philosophy " (used before the present era) 
applied to the modern chemistry, physics and their subdivisions. The ancients 
recognised that physiological phenomena in regard to the " natural " life were 
kin to those of our chemistry and physics. 

Note also the meaning of " nature " in : "the natural appetite is that in- 
clination which each thing has, of its own nature, for something. Wherefore by 
its natural appetite each power desires something suitable to itself." 81 (p. 78). 

5 Animal faculty. — The word "animal" really denotes simply "a thing 
with an anima " ; hence man is an animal. But different people among all nations 
use the word (in their own language) entirely vaguelv, and thus give rise to perennial 
confusion of thought when applying it in daily life. The following meanings are 
assigned to it : 

(i) Generally or collectively, it refers to the presence of life : e.g., anima-te ; 
in-anima-te. 

(") ( Specifically or particularly, (a) indefinitely as (a ') " soul " (a") " mind " 
{a"') "spirit" (quaecumque substantia invisibles " 83 — i. 41, 3, 4). (b) More 
definitely = 4>vxv = lower soul, as opposed to animus, the higher soul, whose seat 
is the " heart," the centre of cognitive and emotional life. 17 (xiv. 153). See Si so 
1.51. ' x 3 ' 

6 Manifestation as " breath " ; or, by means of the breath. See § 161. Breath 
= spiritus, which is defined by S. Thomas as " an instrument of the soul, tenue, 
lucidum, calidum, ex puriore sanguine" (i. 41. 3. 4). cf. preceding note, under 
" spirit." 

7 S. Thomas recognized such powers in animals : " Cogitative and memorative 
powers are not distinct, but the same, yet more perfect (in man, that is) than in other 
animals." 84 (78. i. p. 90). 

8 The heart. — In the platonic view it is the chief organ of the appetitive soul ; 
in Avicenna it is that of the breath. See §§ 136-141. But this would make the ap- 
petitive soul equivalent to the vital faculty, which it is not. Another objection 

■ to the platonic view is explained by S. Thomas 82 (p. 145). 

_ § 130. " Only three powers or parts of the soul are commonly 
assigned — namely, the i^g^He_soul, th^^n^rivg^ouj^and^thi^ 
-a 3li£nal_joul. . . . There are five generaTof powers of "th'e^soul — 
the vegetative, the sensitive, the appetitive, the locomotive, and the 
intellectual^ Of these, three are called souls, and four are called 
modes of living." . . . The reason of this diversity lies in the various 
souls being distinguished accordingly as the operation of the soul 
transcends the operation of the corporeal nature in various ways ; for 



no THE CANON OF MEDICINE 

the whole corporeal nature is subject to the soul, and is related to it as 
its matter and instrument. There exists, therefore, an operation 
of the soul which so far exceeds the corporeal nature that it is not even 
performed by any corporeal organ ; and such is the operation of the 
rational soul. Below this, there is another operation of the soul, 
which is indeed performed through a corporeal organ, but not through 
a corporeal quality, and this is the operation of the sensitive soul ; 
for though hot and cold, wet and dry, and other such corporeal 
qualities are required for the work of the senses, yet they are not 
required in such a way that the operation of the senses takes place 
by virtue of such qualities : but only for the proper disposition of the 
organ. The lowest of the operations of the soul is that which is 
performed by a corporeal organ, and by virtue of a corporeal quality. 
Yet this transcends the operation of the corporeal nature ; because 
the movements of bodies are caused by an extrinsic principle, while 
these operations are from an intrinsic principle ; for this is common 
to all operations of the soul, since every animate thing, m some way, 
moves itself. Such is the operation of the vegetative soul; for 
digestion and what follows is caused instrumentally by the action of 
heat, as the Philosopher says."— Sum Theol. 83 Q. 78, art. 1 : 
Trans., 84 p. 75, 76. 

138. Many philosophers, and all physicians who follow 
Galen, consider that each faculty has its own principal member, 
which forms its storehouse, and from which its functions emerge. 
On this view the rational faculty resides in the brain, and its 
functions proceed from the brain. (Cf. § 130). 

139. The natural or vegetative faculty is twofold, and in- 
cludes (i) the nutritive faculty, which is concerned with the welfare 
and preservation of the individual, and secures nourishment to 
it to the end of life. This faculty resides in the liver, and its 
functions emerge therefrom, (ii) the reproductive faculty, which 
ensures the propagation of the race. This subserves the process 
of generation, and separates the substance of the sperm from the 
humours of the body and fashions the new body according to the 
decree of Allah. The seat of this faculty is the generative organs, 
and its functions proceed from them. 

140. The vital faculty preserves the integrity of the 
breath, and is the vehicle of sensation and movement, and makes 
the breath able to receive these impressions (of sensation and 
movement), and, having reached the brain makes it capable of 
imparting life, and then spreads in every direction. The seat 
of this faculty is the heart, and its function proceeds from this. 
(See 162-167). 

141. Now the great philosopher Aristotle believes that 
the heart is the source of all these functions, though they are 



THE CANON OF MEDICINE m 

manifested in the several" principal organs. But physicians still 
keep to the opinion that the brain is the chief seat of sentient 
life, and that each sense has its own distinct member whereby 
it manifests function. But if physicians thought over the whole 
matter as thoroughly as they should, they would take Aristotle's 
view_ instead. They would find that they have been only re- 
garding appearances instead of realities, taking non-essentials 
for essentials. (Cf. 119, 165). The establishment of this truth 
is for the philosopher and natural scientist, and not for the doctor 
as doctor. But the latter, looking on members as being initiators 
of the faculties instead of as their manifestation — thus despising 
or ignoring philosophy— fails to see which things are prior, 
and accordingly overlooks the proper basis for the treatment of 
diseases, and for the remedying of bodily defects (p). 

" There i s in the body no one beginning, but all parts are alike beginning and 
end ; for a circle has no beginning." (Hippocrates)-. 



I 12 



THE CANON OF MEDICINE 



2. The Natural Faculties 

142. The natural faculties are divisible into two groups : 
(a) dominant or directing, .(b) subservient or obedient. 

The dominant faculties are twofold : (i) concerned with the 
preservation of the life of the individual ; — the nutritive faculty 
and the augmentative faculty (power of growth), (ii) concerned 
with the preservation of the race : — the generative faculty ; and 
the formative or plastic faculty. 



i3i- 



Classification of the Natural Faculties. 



General 
purpose. 


Dominant 

faculty 

(hadima) 


Subservient 

faculty 

Khadama. 


Synonyms. 


Quali- 
ties. 


Element 


Corres- 
ponding 

Mental 
process. 




: / 

d '■■ 
o 

'-£ i 
'C j 

-t-> ! 

3 : 
pi 

O 
m 

Nutritive -g 
(ghazia) B ( 
(143) "g S 

3 ! 

3 

c 

o 
xi 

: \ 


i. Attractive 
Jadhiba 
(147) 


Apposition. 

Presentation 

Prosthesis. 


Hot and 
dry. 


Fire. 


Percep- 
tion. 




ii. Retentive 
Masika (148) 


Agglutinative 

Adhesion. 

Prosphysis. 


Cold and 
dry. 


Earth 


Memory. 


The 
Individual 


iii. Alterative 

Hadima 

(149) 


Transforma- 
tive. 

Assimilative- 
poietic 

(e.g. haemo- 
poietic). 


Hot and 
moist. 


Air. 


Cogitation 




iv. Expulsive 
Dafi'a 
(150) 


Propulsive 
Expeditive. 


Cold and 
moist. 


Water 


Expres- 
sion. 




Augmenta- 
tive 
(namia) 
(143) 




Auxetic. 

Plastic. 

Incremental. 






Acquisi- 
tion 

of know- 
ledge. 


The Race. 


Generative 
(muwaliida) 
(145) 
(i) in the 
strict sense 
(2) primary 
transforma- 
tive faculty 
(mughayyara 1 




The mascu- 
line factor. 
(Tr.) 




Aether 


Creative 
and Inven- 
tive facul- 
ties. 




Informative 
(masawwira) 
(145) 




Plastic. 
Operates in 
utero. The 
feminine 
factor (Tr.) 






Construc- 
tive 
faculties. 



THE CANON OF MEDICINE 113 

143. The faculties pertaining to the preservation of the life 
of the individual. 

The nutritive faculty is that whereby the aliments are 
transformed into the likeness of the thing nourished, thereby 
replacing the loss incidental to the process of life. 

The augmentative faculty is that whereby the increase in 
size of the body in" all directions in just proportion is secured. 
This is brought about by means of the substances derived from 
the aliments. The nutritive faculty is subservient to this 
augmentative faculty in so far as it enables the preparation of the 
requisite substances from the aliments, but growth will not occur 
unless more is supplied than is lost. However the supply of 
more substances than are lost does not necessarily produce 
growth. Growth implies an increase in all directions in the 
proper proportions. To become fat or obese with advancing 
years, after being slim, is not growth. It is not growth unless 
the increase is in all dimensions and in natural proportions, 
so as to culminate in a state of perfection of growth. Adiposity, 
for instance, is not a perfection of growth before adult age, 
any more than it is a perfection for the figure to be very slim after 
maturity to a greater degree than natural. 

144. There are three special functions in the process of 
nutrition, (i) the apposition of the altered material, namely, 
the blood, or a humour which is potentially like the tissue to be 
nourished. If this process is defective, as may happen in disease > 
there is " atrophy," which is a defect of nutrition, (ii) agglutina- 
tion' — a later stage. Here the nutriment apposed to the tissue 
is now fully united up to it, and made a part of it. This may be 
lacking owing to disease, and then occurs what is called " fleshy 
dropsy." (iii) true assimilation — a stage still further where that 
which has been made into a part of a member becomes absolutely 
like it m all respects, in essence and colour. This fails in such 
conditions as leprosy and vitiligo, in which cases the first two 
functions are achieved, but not the third. 

These three procedures are the work of the transformative 
power. This is really a single faculty, though distributed among 
the respective members. For in every member this faculty is 
corresponding to its temperament, and so transforms the aliment 
into the likeness (ad-similis) of that member ; in each case it 
differs from that which transforms aliment into the likeness of 
the various other members (or tissues). So (we may say) the 
transformative faculty of the liver ramifies throughout the whole 
body. 



ii 4 THE CANON OF MEDICINE 

145. The faculties pertaining to the preservation of the race. — ■ 
The generative faculty is two-fold, (i) That which gives rise to the 
male and female " sperm," the reproductive units, (ii) the forma- 
tive power (i.e., in the male element) which separates from one 
another the various faculties in the sperm and rearranges them in 
such a way that each member (and tissue) receives the tempera- 
ment appropriate to it— thus, to nerve, its distinctive tempera- 
ment ; to bone, its distinctive temperament. The one " sperm," 
apparently homogeneous, opens out in all these directions. This 
is called the primary transformative faculty. 

The informative or plastic j : acuity (lit. as in making a sculpture 
painting) is that (in the female element, Tr.) whereby, subject or 
to the decree of Allah, the delineation and configuration of the 
members is produced, with all their cavities, foramina, positions 
and relations to one another, their smoothness or roughness, and 
so on' — all being controlled up to the final limits of their natural 
growth (dimensions). Subservient to this faculty, in regard to 
that part of the nutriment which serves for the preservation of 
the species, are the nutritive faculty and the power of growth. 

§ 132. From the annotations by Costaeus : reproduction implies a plastic 
faculty ; and that implies transformative power, and that depends on the four 
qualities. Growth cannot occur without nutrition ; nutrition cannot occur without 
agglutination or assimilation ; agglutination cannot occur without apposition ; 
assimilation cannot occur without transformation ; transformation cannot occur 
without retention ; and retention cannot occur without affinity. Each successive 
step entails the removal and excretion of the products and by-products of the 
preceding steps, for these are hindrances to reproduction, nutrition and growth. 

3. The Faculties Subservient to the Natural Faculties 

(Vegetative Life) 

146. Vegetative Life (i.e. the natural faculties) is sub- 
served by four faculties : attractive,* retentive, transformative,t 
expulsive. 

147. The attractive faculty was created so that the body 
could draw to itself whatever nutriment is required for its 
preservation. The longitudinal fibres in an organ form the 
instrument used for the purpose. The liver attracts the chyle 
from the stomach by sucking, as it were, the purer parts thereof 
by way of the mesenteric veins. 

148. The retentive faculty was made so that the material 
so drawn in could be held (in position) during the time that the 

* The word attractive, in the original, is primarily with the thought of the 
attraction of (female) beauty and has a peculiarly appropriate application in 
consequence. 

■f " Ferment " actions of the body belong here. 



THE CANON OF MEDICINE u 5 

alterative (transformative) faculty is engaged in preparing sound 
nutritive substances from it. The instrument employed for this 
are the oblique, and in part, the transverse fibres. (In the case 
of the_ liver, the chyle is retained in it long enough to enable the 
sanguificatory power to act upon it.) 

149. The alterative or transformative faculty is that which 
alters the material attracted and held by these two powers. It 
transmutes the material from its former state until it has become 
worked up into a temperament such as enables it to become 
efficient nutrient material. This process is " digestion '-' in the 
strict sense. 

At the same time it produces a change in the superfluities 
so that they can be easily discharged from the member containing 
them. This process is called " maturation." By its means three 
things happen : (i) — the texture of the superfluities becomes 
attenuated, when it is inspissation that hinders expulsion ; 
(2). — the texture of the superfluities becomes thickened, when it is 
attenuation that prevents their discharge ; (3) — the superfluities 
are entirely broken up, if it be viscidity that hinders expulsion. 
It is a mistake to use the terms " digestion " and " maturation " 
as synonymous. 

150. The expulsive faculty is that whereby the superfluities 
from digestion are expelled. Superfluities are such as are 
unsuitable as nutriment, or are in excess of requirements (and 
therefore " superfluous "). By means of this faculty, the waste 
matter is expelled into the bladder as urine, and other excreta 
through their several appropriate organs and apertures. Where 
there are no orifices, the wastes are transferred by this faculty 
from noble to less noble organs ; from hard structures to soft 
ones. And if there is a diversion of waste matter from the proper 
route, the expulsive faculty cannot remove as much as otherwise. 

151. Inter-relations between the faculties and the qualities. — - 
These four natural faculties are subserved by the four 

primary qualities — heat, cold, dryness, moisture. Strictly 
speaking, heat is the underlying factor in all the subservient 
faculties. 

152. Action of cold. — While cold aids all four faculties 
it does so indirectly and not directly — except in so far as 
it is the contrary of all the faculties. For all the facul 
ties act in virtue of movement, which is shown not only as 
attraction and expulsion, but even in the transformative 
process (digestion proper) ; for the latter consists in the 
separation of gross and aggregated particles from one another, 



n6 THE CANON OP MEDICINE 

and in the condensation together of the finer and separated 
particles. The movements of dispersion and aggregation 
are simultaneous. Movement is also concerned indirectly 
in the retentive faculty, because the transverse muscular 
fibres come into play. Coldness enfeebles, stupefies, and morti- 
fies, and hinders this faculty in all its functions ; yet, indirectly, 
it helps it by fixing the fibres in the position referred to._ There- 
fore it is not directly concerned with the faculties ; it simply 
causes their instruments to be in a state which will help their 
functions to be maintained. 

Coldness aids the expulsive faculty (i) by preventing the 
dispersal of the gases which favour peristalsis, (2) by keeping the 
particles of the aliment coarse, (3) by its astringent action upon the 
transverse muscular fibres. In these ways coldness renders the 
instruments of the faculty in an appropriate state. Evidently, 
then, it only helps the faculty indirectly. Did it act directly, it 
would obstruct and weaken the movements. 

153. Action of dryness. — Dryness is directly instrumental 
in the functions of two faculties. — namely the alterative and re- 
tentive. It is auxiliary in the case of the other two— the attractive 
and expulsive. This is because dryness delays the movement of 
the breath, enabling it to take on with it those faculties which it 
has encountered with a vehement impact. It also prevents the 
moisture present in the substance of the breath or its instrument 
from flowing away. Dryness helps the retentive faculty because 
it favours (muscular) contraction (i.e. upon the contents of the 
organ). The transformative faculty needs moisture (and not 

dryness). 

154. Comparative relations between the qualities and the 
j 'acuities. —If one compares the degree of active and passive 
quality requisite for the various faculties, one finds that the 
retentive faculty needs more dryness than heat. This is because 
more time is required for a movement to come to rest than is 
needed to start a contractile movement of the transverse fibres. 

155. Heat is necessary for movement, and it takes only a 
short time to produce its effect, so that the remainder of the time 
is occupied in holding the material and coming to a state of rest. 
This explains why the temperament of juveniles tends to moist- 
ness, for their digestive power is weaker. 

156. The attractive faculty needs more heat than dryness 
because the chief feature of attraction is movement, and move- 
ment demands heat. The organs concerned must move rather 
than be at rest and contracted (for which dryness is needed). 



THE CANON OF MEDICINE 117 

Not that much movement is required for this faculty, though at 
times violent activity becomes necessary. Attraction is brought 
about (a) by an attractive faculty — as when a magnet attracts 
iron, (F) by heat, as when oil is drawn up in a lamp. — Some 
physicists assert that the last-named is really an example of filling 
up of a vacuum. 

Heat increases the power of the attraction exerted by the 
attractive faculty. 

157. The expulsive faculty requires less dryness than the 
attractive and retentive faculties, because there is not the need 
of the muscular contraction requisite for retention, nor for the 
apposition necessary for attraction ; nor a need to maintain 
contraction upon an object until the next stage of the process 
is reached. Nor is there a need for repose ; but, on the contrary, 
there is a need of movement, and also a small amount of inspissa- 
tion — -just enough to ensure that degree of compression and 
expulsion which is necessary to make the contracted viscus an 
instrument. Lastly, whereas the retentive faculty requires a long 
period of time and the attractive power only a short period — 
namely that necessary to bring one thing in contact with another — 
so there is less need of dryness. 

158. The transformative faculty requires more heat than 
the other three. It does not need dryness but moisture, for by 
moisture the nutrients are rendered fluid and so become able to 
enter the pores and become moulded into the conformation of the 
channels to be traversed. But one must not suppose that because 
moisture aids digestion, juveniles (whose temperament is moist) 
can digest hard or indigestible foods. This can be done in 
youth, but here the reason is not to be found in their moisture ; 
it is because at that period of life the "nature" is similar to that 
of the foods in question. Foods of hard nature are not appropriate 
for the juvenile temperament (which is - soft), and therefore their 
transformative faculty cannot cope with such food ; their 
retentive faculty cannot hold it, and their expulsive faculty rapidly 
expels it. In the case of youth, on the other hand, such hard food 
is quite suitable for nourishment. 



n8 THE CANON OF MEDICINE 

159. The following brief .table gathers together these 
points : 



Attractive Faculty. 
Retentive Faculty. 
Alterative Faculty. 
Expulsive Faculty. 



Duration of muscular 
contraction. 



Quite short 
Long ; continued. 
Continued. 
Momentary. 



Amount of longitudinal 
movement achieved. 



Marked. 
Moderate. 
None. 
Considerable, but 

superadded from 

without. 



The alterative faculty needs liquefaction and commingling 

of substances. 

160. So the various faculties make use ot these tour 
qualities in diverse ways and to different extents. 

si« Thus, the attractive faculty is not equal in degree in all organs. Heat 
is stronger in the liver than in the stomach and intestines, m arteries than m veins 
The livfr at one time is hotter (and therefore the attractive faculty is greater) than 
It another So also in the case of the stomach. Hence if the stomach is empty 
and the liver is hot, the stomach will draw out the serous humour ^le from the 
liver Tust as a strong person can take something out of the hands ot a weak 
plrson if he wants to, or, on another day, the weak person is the stronger* (Cf. 
Galen, Daremberg, ls ii. p. 3°7)- 

" The operation of the vegetative principle is performed by means of heat, 
the property of which is to consume humidity."— (Sum. Theol." 75, P- »i-) 

4. The Vital Faculty. 

161. The power which the members receive before they 
can acquire the capacity for the faculties of sensation and move- 
ment, and for accomplishing the various functions of lire, is 
called the "vital faculty." Closely related to this (subject) is 
(that of) the " breath," and therefore also of the emotions of 
fear and anger, because they coincide with the expansion and 
contraction of the breath, (/>.) 

8 1 34. Vital faculty = virtus vitalis = vitality = innate heat == 
" spirits " (corporeal, vital, natural, animal) = breath (which is its 
manifestation) = Spirit = " refined form of bodily substance or 

* There is a striking parallel to this passage in the " It'ung cheng mo " (circa 
ad 10.56) on page 25 of the subdivision " Mo Chueh Chih Chang : referring 
to the changing dominance of the types of " breath " in the various organs per- 
ceptible by a study of the pulse. The author states : " it is just hke the case of the 
Hng of Wu, who obtained the supremacy over the dominion of Chu, and then ne- 
Sected his own defences. The king of Yu seized the advantage of his unprotected 
state, and in turn obtained the possession of his territories. 



THE CANON OF MEDICINE n 9 

fluid believed to act as a medium between mind and the grosser 
matter of the body." 1 ? (xv. 220) = " a kind of very subtle body 
which penetrates all parts of the material body and infuses them like 
the essence of a rose, oil in sesame, butter in milk " (Motazelite view 13 ) 

Cf. § 118, § 136; and see 167-173. 

In part it corresponds to " life principle," and also in part to 
"substantial form." But it is not the " soul " ; it is one of the powers 
of the soul ; the soul is a " bundle of life " ; i.e., a bundle of faculties 
and powers which complete the material body. Soul: body:: 
vibration : atom. 

162. We now proceed to enlarge this brief statement. 
On the one hand there are bodies of dense substance. — the organs 
and tissues — which are derived from the dense particles of the 
humours of the corresponding temperament ; and on the other 
there is the " breath," derived from the rarefied attenuated 
particles of the humours of corresponding temperament. 

163. Physicians regard the liver as the seat of manufacture 
of the dense part of the humours, and the hearts that of the rarefied 
part. Really speaking, as soon as the breath and the appropriate 
temperament meet, the vital power comes into being, and thus 
all the members are rendered capable of receiving all the other 
faculties (of the soul) — sensitive and otherwise. The sensitive 
faculties do not appear in the breath and members until this vital 
power has come into being, and so even should the sensitive 
faculties in a given member be lost, life will remain in the part 
until the vital power has forsaken it. Does one not find in prac- 
tice, how a limb is devoid of sensation from paralysis (whether 
as^ a result of 2. temperament which renders it incapable of re- 
ceiving sensation or showing movement, or because of some 
obstruction to the current from the brain and nerves into the 
limb) yet continues to live ? and does one not find that a limb 
which has lost the vital power loses also sensation and movement, 
dies, and undergoes putrescence and decomposes ? That shows 
that the power which renders a member living is still there even 
in the paralysed member, so that sensation and movement would 
return again, could the obstruction be removed. In fact, the 
intact possession of this vital power makes the limb always 
ready to receive the attributes in question. That which obstructs 
these attributes does not interfere with the power of receiving 
vital breath ; the member itself is not dead. 

Further, it is not the nutritive faculty that prepares a member 
for receiving sensation and motion. It is not the nutritive 
faculty that is fundamental for the life of a member. One cannot 
say that a member perishes as soon as the nutritive faculty is 



120 THE CANON OF MEDICINE 

abolished. The statements just made about a paralysed limb 
apply equally to the nutritive faculty. For sometimes the 
nutritive faculty ceases in a member and still the member 
continues to live. Sometimes the nutritive faculty is unimpaired 
and nevertheless the member tends towards death. 

Then again, if it be the nutritive faculty which provides the 
power of sensation- and movement, should not plants also share m 

these powers ? 

164 Hence it is clear that there is something else preparing 
(the members for these powers), something akin in temperament 
to itself— and this something is the vital faculty. This is that 
faculty which appears in the breath at the very moment at which 
the breath develops out of the rarefied particles of the humours 
As the philosopher Aristotle says, from that moment the breath 
receives its first beginning and all the other faculties flow out 
from it. Not that the activities of these faculties are directly 
derived from the breath, any more than the sensation (as doctors 
agree) proceeds from the animal breath in the bram until the 
serase-impression has passed the crystalline lens, or the tongue 
or the other sense-organs. It is when the particular portion ot 
the breath reaches the appropriate parts of the bram that it 
becomes impressed with the temperament of the bram and there- 
by becomes adapted for the operations of the faculties proceeding 

from and reposing in it. , j .• 

The same applies in the case of the liver and reproductive 

organs. , . ^1 

165 The opinion of physicians differs from this. Iney 
state that unless the temperament of the breath becomes altered 
in the brain the breath is not capable of responding to the soul 
(anima, nafs), the source of sensation and movement. But they 
admit that the initial temperament of the breath plays a part in 
enabling it to receive the primary vital faculty. The same thing 
holds for the liver, and other principal members. From this 
point of view, however, there would have to be a separate soul 
(anima) for every kind of action; the soul would have to be really 
an aggregate of various souls, instead of being one single agent 
from which the several faculties emanate. 

6nt. Scholastic argument against such a conclusion.—" If 
man is to be understood as three or two (souls) using a body, it 
follows that man is not one thing, but two or three for he is three 
souls or at least two. And if this be understood of the intellective 
soul only, so that the sensitive soul be understood to be the body s 
form, and the intellective soul, using the animated and sensified 
body, to be a man, this would again involve absurdities, namely that 



e 



e 



THE CANON OF MEDICINE 121 

man is not an animal,. but uses an animal ; and that man does not. 
sense but uses a sentient thing. And since these statements are 
inadmissible, it is impossible that there be in us three souls differing 
in substance, the intellective, the sensitive, and the nutritive." 
(S. Thomas 82 p. 144). 

If the primary temperament helps the breath to receive the 
primary faculty, then the vital powers, the breath and the 
faculties are hs perfection. The primary vital faculty is not 
sufficient by itself to enable the breath to respond to the other 
faculties, but needs an appropriate temperament first. The 
physicians also claim that this faculty, besides paving the way 
for "life," itself initiates the movement of the attenuated 
spiritual substance (the breath, that is) towards the various 
members (organs), and is the agent which brings about the con- 
traction _ and expansion of ■ respiration and pulse. In that it 
assists life it is " passion " ; in that it assists the activity and 
functions of mind and pulse it is " action." 

166,, _ The vital faculty resembles the natural faculties in 
that its actions are beyond the scope of the will. It resembles the 

animal (sensitive) faculties in carrying out contrary actions ■ 

namely, it dilates and contracts at one and the same time, effecting 
two contrary movements at once. 

167. The diverse use of these terms in philosophy and 
medicine. — When the ancients use the word " soul " (nafs), 
they refer to the earthly or corporeal soul, the perfection of the 
corporeal body, which is its instrument ; the source of all those 
faculties upon which the movements and various bodily opera- 
tions depend. The natural faculty, in medicine, thus corresponds 
to the " animal " faculty in philosophy. The soul (nafs) is not 
understood in this sense but is " the power which originates 
understanding and voluntary movement." The natural faculty, 
in philosophy, means " every faculty from which any bodily 
function proceeds." But this is not the "animal faculty" 
of medicine but a natural faculty of a higher order than that 
named " natural " in medicine. So, if natural faculty is defined 
as " that which is concerned in nutrition whether for the preserva- 
tion of the individual or of the race," then another, and third 
term would be required to represent this other faculty. Anger, 
fear, and similar emotions are passions of this same faculty' 
and admittedly arise from the senses, the judgment and the 
apprehensive faculties. 

The proof of the existence of this third faculty, and of its 
being single or multiple, is a question for natural science, which 
is part of philosophy. 



122 



THE CANON OF MEDICINE 



Expressed in another form, 
Term in Philosophy 



Corresponding term 

in Medicine 
Scope of term 



Corporeal Soul 

( = lower reason) 
Animal Faculty 



Seat of movement, 
action, operations 



Natural Faculty 

(Higher) natural 

Faculty 
Seat of passions 
and starting point 
of ' apprehension.' 



Animal Faculty 

Natural Faculty 

Vegetative 
Functions 



The important subject of the "breath" needs further elucidation at this 
point The conWty oAhe ■■ Canon" is therefore here interrupted by introducing 
?he opening passage of " De viribus cordis," and an explanatory extension. 




THE BREATH 
Its Origin, Forms, Sources, and Relation to the Being 



168. 



I. THE ORIGIN OF THE BREATH. 




•J created the left side of the heart, 
A and made it hollow in order that 
'~"J?Lj& it should serve both as a store- 
house of the breath and as the 



seat of manufacture of the breath. He also 
created the breath to enable the faculties of the 
^ " soul " to be conveyed into the corresponding 
f^^^l members. In the first place the breath was to 
t^==^ be the rallying-point for the faculties of the soul, 
and in the second place it was to be an emanation into the 
various members and tissues of the body (whereby these could 
manifest the functions of those faculties). 

169. Now He produced the breath out of the finer particles 
of the humours, and out of igneity ; and at the same time pro- 
duced the tissues themselves (the visible body) out of the coarser 
and terrene particles of these humours. In other words, the 
breath is related to the attenuated particles as the body is related 
to the coarser particles of the same humours. Just as the 
humours are intermingled to produce a temperamental " form," 
whereby the members of the body are enabled to receive a physical 
appearance, impossible were they separate ; so the attenuated 
portions of the humours, being intermingled into a temperamental 
form, enable the breath to receive the powers of the soul — 
impossible were the humours separate. 

170. The beginning of the breath is as a divine emanation 
from potentiality to actuality proceeding without intermission 
or stint until the form (lit. preparation, state) is completed and 
perfected. Each member, though derived from the self-same 
substance of the humours, nevertheless has its own particular 
temperament— for the proportional quantities of the (denser 

123 



i2 4 THE CAN0N 0F MEDICINE 

portions of the) humours and the form of their commixture are 
peculiar to each member. Similarly, although derived from 
the same attenuated portions of the humours, nevertheless 
each of the three breaths, (natural, animal and vital) has its own 
particular temperament, for the proportional quantities of 
the more attenuated portions of the humours, and the manner 
of their commixture are peculiar to each breath. 

171 . Although the body consists of several members, there 
is one from which they all originally arose. As to what this 
member actually was, there are various opinions. The fact 
remains that one member necessarily came to light before other 
members could arise out of it/ Exactly the same is true 
in the case of the breaths. There is one single breath which 
accounts for the origin of the others ; and this breath, according 
to the most important philosophers, arises in the heart, passes 
thence into the principal centres of the body, lingering m them 
long enough to enable them to impart to it their respective 
temperamental properties. Lingering in the cerebrum it receives 
a temperament whereby it is capable of receiving the faculties 
of sensation and movement (sensitive faculties); m the liver, it 
receives the faculty of nutrition and growth (vegetative 
faculties) ; in the generative glands it acquires a temperament 
which prepares it for receiving the faculty of generation (re- 

172. The foundation or beginning of all these faculties 
is traceable to the heart, as is agreed upon even by those philoso- 
phers who think that the source of visual, auditory and gustatory 
power lies in the brain. 

173. Some philosophers consider that the breath is made 
able to receive these faculties, and so be perfected, in other 
members (than those named). Thus, visual power results from 
the union of the temperament of the breath with the moist 
temperament of the crystalline lens ; that the auditory power 
results from the union thereof with the temperament of the 
auditory nerve ; that gustatory power is produced by the 
mediation of the moist temperament afforded by the soft 
spongy sub-lingual glands. 

Others reject this view and consider that the breath carries 
the faculties from the brain, and receives nothing from the 
temperament of the member to which it travels, as nothing is 
necessary to perfect it. The member itself is an instrument well 
adapted for the action of the vegetative faculty, and contributes 
nothing of its own essence. 



THE CANON OF MEDICINE 



125 



Other philosophers have claimed that the breath acquires 
all its powers in the heart, emerging therefrom in a state of per- 
fection ; hence the liver and brain do not add to It. 

However, a careful enquiry into the truth shows that all such 
views are untenable. The only possible view is that the breath 
obtains the perfection of the given faculty in that member which 
is the instrument of such faculty. 

The continuation of the translation of Be viribus cordis is resumed at 1053. 








Explanatory Extension of the Subject of " The Breath." 

§ 136. Synonyms.—" The breath of life " (Gen. 2 7 • Quran 
32-9) Souffle de vie; Ruach (Heb.) ; Ruh (Persian, Arabic)- 
Hu (Sufi) ; Ch'i (Chinese ) ; Prana (Hindu)* ; Hauch (German) • 
Spirit (as a translation of " spiritus," for which " breath " is the better 
equivalent: see § 134, and § 129, footnote; spiritus is the Latin 
translation of the Arabic nafs). 

Primordial aura (Bruce, 11 p. 101) ; "ether" ; vivifying prin- 
ciple ; vital fluid ; vital (cosmic) force. 

Definition : that which binds the vegetative and sensitive life 
into one connected whole. It is common to, and like in, all living 
things. & 

" Thatwhich centres in the cardio-pulmonarv centre. "(Baraduc. 110 ) 
" It is a subtle vapour which rises from the blood, diffuses itself 
to the remotest arteries, and resembles the sun in luminositv fCh 
M. 7 p. 8.) y ' K 

Negative definition. — " Breath " is not " respiration," " breath- 
ing," drawing in breath. Therefore it is not the equivalent of 
anhelitus, nafas, anfas, Atem. 

The expression " he breathed his last " actually describes 
the departure of the " breath," but there are two events taking 
place simultaneously, and the literal respiration is only one of 
them. 

It is not " soul " = anima. The latter is the Latin translation 
of the Arabic ruh in various passages. 

It is not " vitality," for this is the manifestation of breath. 

* The Hindu system of physiology recognises five breaths as supporting the 
body. They are : Prana (the air inhaled), Apana (has a downward course). Samana 
(essential to digestion), Udana (has an upward course, or passes into the head) 
Vyana (pervades the whole body and moves in various directions, transverse and 
otherwise ; therefore, equivalent to the " breath " of the present section.) But 
Prana mcludes the rest, ordinarily speaking.— E. A. C, Kaviratna, Charaka Samhita 



126 THE CANON OF MEDICINE 

Vitality stands for the vegetative soul. Thus, enfeebled vitality 
means lessening of the ability of the vegetative soul to accomplish 
some or all of its faculties.— Therefore it is not "life." (" Allah made 
life to be in breath." Night 913, Burton, 10i v. 422).— It is not the 
" vital air " of the 18th century chemists. It is not even vital 
faculty " It is not amenable to either physical or chemical methods 
of investigation. It is not a force at all, and therefore not analogous 
to electricity, magnetism, heat, etc, though in the course of its 
activity it manifests all such phenomena. 

Breath is not " individuality." 

Description by analogy. Being immaterial, and representing 
a notion foreign to Western thought, breath is almost indefinable, 
whereas to the Eastern mind there seems little difficulty in the con- 
ception Analogies— such as to flame, a pendulum, a ladder or lift 
to a higher plane of being, a chain linking the three aspects of the soul, 
to lio-ht, to vibrations, and so on— are necessarily misleading. 

& By picturing the breath as a sort of aura pervading the body, 
with a polarity correspondent with the cosmic ether (its source, whence 
it individualized into the human being), the conception of orientation 
fin time and space) becomes feasible. Angle of incidence is then to 
be considered, both in regard to every direction of space and to time 
of day. Thus an infinite variety of constitution m these respects 

becomes obvious. , . . • j • 

R l37 —T/ie substance of the breath.— -This is mentioned in 
several passages in the Canon. Though immaterial, the breath needs 
a material basis or substrate. The substance is described as twofold : 
(a) an aqueous vapour, in the case of healthy breath, as occurs when 
the humours— the source of the substance of the breath (169)— are 
healthy (b) A fuliginous vapour, like the mist of the early morning 
landscape, if the breath be unhealthy— namely because, superfluities 
are present in the humours. i 

A more tangible idea of the substance of the breath is furnished 
by taking it as partly consisting of oxygen, for the functions of oxygen 
in the body are the same as those attributed to the breath which it 
carries. Thus to quote L. S. Beale, " oxygen is necessary to dis- 
integrate the soft formed material and combine with some of its 
constituents."— That is, breath=mf, where m is oxygen. 

In the Hindu system, there are ten substrates for the life-breaths.— Charaka, i. 
402. — But these are anatomical. 

The " primordial substance " of Chinese philosophy, the ground 
of all phenomena, physical and psychical, fulfils the theory of the 
breath. It is invisible and intangible, but manifests as matter (solid, 
fluid gaseous), as psychic existence, and as spiritual existence. This 
substance agrees with " breath " in showing cyclical changes, passing 
from energy to inertia, from activitv to passivity, incorporeahty to 
corporeality. The incorporeal is " the rule of existence implanted in 
every living being" ; and " Li" is the Nature implanted by the 
Decree. This principle of activity appears in modernist philosophy 
as " mind." (Cf. Bruce, 11 p. 109.) 



THE CANON OF MEDICINE 127 

§ 138. The const-ant activity of the Breath. Were the breath 
not in constant activity, the body would be " dead.' 5 - The activity 
consists of (i) changes in quality, (ii) movement from place to place. 
Actually, both occur simultaneously, but description would be im- 
possible without taking each form separately. 

(i) Changes in quality. This is a rhythmic waxing and waning 
in intensity. ; a change from a strong phase to a weak one, and back 
to a strong one ; a change from positive to negative ; an ebb and 
flow; a condensation or concentration (" inspissation ■") and an 
expansion or rarefaction (attenuation "). In the one phase there is 
attraction of energy from without, symbolized by inhaling air ; in 
the other, there is repelling of energy from within, symbolized by 
exhaling air. 

These phases of movement are represented by the terms jelal 
jemal (Persian) ; jalal, jamal (Arabic) ; shiva, shakti (Urdul ; 
Yin and Yang (Chinese); 23 masculine, feminine; active, passive; 
etc. The rise is called Urooj in Persian terminology, and the fall', 
Nasool ; it isa rise from no intensity (incipience) to great intensity ; 
there is a period of maximum intensity (maturation) and a fall from 
thence to no intensity (decay, defervescence, decline). 

This cycle of the breath is continuous, but varies in rate — hourly 
two-hourly, twice-daily, daily,* weekly, monthly, seasonal. Accord- 
ing to its changes, so does the feeling of well-being of the person 
change ; according to its changes, so are there differences of bodily 
vigour in one and the same person. Every family, every race has its 
type of " breath." Wherever we turn in living Nature we can see the 
traces or signs of this " pulse of life "—in vegetable life, in animal 
life, even the greater range of human history itself, the rise and fall 
of nations, the rise and fall of pandemics ; the solar and planetary 
cycles— all show the traces of this activity, though no doubt many 
would consider the connection with " breath " very intangible in 
these instances. 

The explanation of this activity. This is to be found in the fact 
of the cyclical changes in the imponderable elements, for the two 
phenomena, as already suggested, are part and parcel of the same 
phenomenon. Thus, breath, conceived as a vibration rate, is now 
slow, now quick, now coarse, now fine. The range and changes of 
vibration from " earth " (slow, coarse) to " ether " (quick, fine), and 
back, as has been intimated, are associated with changes of activity 
of the breath. These elements are, as it were, the points d'appui of 
the breath, and they constitute an " immaterial " circulatory-system. 

§ 139- — Relation of breath to temperament and the emotional 
character.— So close is the relation between " breath," " imponder- 
able _ elements " and "temperament" that description of the one 
readily lends itself to being a description of one or both the others If 
we trace changes in " earth," " water," etc., we are at the same time 
tracing- changes in the activity of the " breath," and we use words 
which apply to both " temperament " of the old sense, and emotional 
character as spoken of to-day. Dominance of " water "is as much as 
* Chloride-retention has a cycle of three or four days (Vallery-Radot "'p. 308). 



128 THE CANON OF MEDICINE 

to say " the breath remains in the ' water ' phase over a longer period 
of time than in other phases— in this person." It also goes with 
" jemal " type of character/the exact form of manifestation varying 
according to other factors in the " make up "—e.g., quiet endurance, 
silent submission to pain, ardour of aesthetic emotion, keen sense of 
beauty, love of certain kinds of music, certain colours, flowers, etc. 
(Note,- then, how intimate this idea of " constitution " becomes.) 

The construction of a graph to represent possible variations may 
be helpful, as long as its essentially schematic character is realized. 



■*? 



i*7K 



C 



sN" 



■9- 



A 



r 



3* 



r$ 



u 



•tf 



•O 



V- 



The dotted area represents the 
supposed temperament used in the 
sense of 26, sqq. If it were ideal, it 
-would be an exact square. 

Note the necessity for four scales. 
Reflection on this diagram, in the light 
of the text, should bring out many 
points which otherwise require lengthy 
description. Strictly, no doubt, the 
diagram would be improved if it could 
be conceived in " solid form." 



Diagram of a Person's Temperament. 

To give another illustration — dominance of " fire." The 
following are its modes : (i) the vibration-rate of the " breath " 
remains longer in the " fiery" phase than in other phases and in 
other persons*; or, weeks elapse before it reaches its climax (kemal 
stage) ; (2) the temperament is " fiery," ; (3) the person is called " of 
hasty disposition," " hot-tempered," he is " prone to anger " ; (4) the 
climax of the fire-element may be reached suddenly : e.g., persons of 
"explosive" temperament or disposition; the blood '" boils " ; 
(S) the associated character is of jelal type, taking different forms 
according to the manner in which the patient reacts to the circum- 
stances of life: e.g. (a) possession of great physical strength, 
(b) pugilistic power, (c) courageous in danger, (d) irascible char- 
acter, (e) originality of thought, (f) ambition, _{g) a person with 
unshakable gentleness, despite opposition (e.g., in some " saints "), 
(h) proneness to enthusiastic beneficent arts, (i) zealous char- 
acter, (7) cruelty of certain kinds (other cruel persons are called 
" cold-blooded "), (k) strong desire. The whole range of human 
activity can be drawn on for opposite examples. 

. So also a slow rhythm of breath goes with tranquillity of mind, 
and a liking for poetry and music. A moderate rhythm goes with an 
active mind, keen to accomplish. A quick rhythm goes with energy, 
forcefulness, and activity to a degree liable to lead to confusion of 
mind and premature exhaustion of the body. 

§ 140. Relation of quality of breath to will-power. The will- 
power should dominate the breath. But it cannot do so consciously 
if the individual is ignorant of the existence of " breath " ; persons of 
vigorous will-power will dominate it unconsciously. It would be 

* The ." ira " type, where " ira " is not simply the passion (anger), but a 
definite jelal-type. 



THE CANON OF MEDICINE 129 

easy to see that dominance of will-power by the breath should be very 
common, with the corollary that actions supposed to be initiated by 
the personality are really quasi-automatic. 

The will-power may be used to " develop the breath " ; that is, 
the way the breath flows through the body, through the various 
(nerve) centres. 

§ 141.. (b) Relation to < " innate heat." The subject of innate 
heat is very prominenfin the pages of the Qanun ; it is closely linked 
with " vitality " (popular sense of the word) ( e.g., " enfeebled 
vitality," " has very little vitality " ; " full of ' vim '"). The close 
relation to " breath " is expressed by saying that as the breath wanes 
(nasool phase), the innate heat lessens ; as the innate heat is restored 
in the course pf nutritive processes, so the breath " waxes " (urooj 
phase) ._ The rate of waxing and waning of the innate heat varies with 
the individual and shows a relation with the similar phases of activity 
of the breath. Innate heat is expended simultaneously with " breath," 
and at the same time comes that indefinable phenomenon — real 
enough nevertheless— called " atmosphere," " personality," " radi- 
ance," " aura." 

This subject bears on the theory regarding the appearance of 
pathological changes in the humours. Normally, the innate heat 
is the agent which separates normal effete matters from healthy 
humpurs. But in disease — that is, when the cycle of the breath is 
not in harmony with the process of formation of the humours- 
injurious effete matters (acrid, conosive, etc.) appear as by-products 
of the abnormal humoral state ; the latter being the result either of a 
change in the innate heat or of a conflict between this and " foreign 
heat " (i.e. bacterial products : 485 : § 283). 

§ 142. (c) Relation to metabolic changes spoken of (§ 83") 
under the picturesque title " dance of the elements." The picture of 
imponderable elements dipping down into the world of ponderable 
elements (or, to be precise, the individual human being), and entering 
into the changes of metabolism expressed as changes of pivot of 
function from C to O, or H, or N, or S, or P in compound after 
compound, and break-down into C0 2 or H 2 0, etc, or as formation of 
tissue cells and their subsequent necrobiosis, etc. — all this is com- 
pleted by the view of the breath, passing from phase to phase, from 
strong to weak, not merely in one organ, but in every particle of the 
whole being. With the ascending phase of the breath come the 
formation of increasingly complex substances,— " generatio " ; 
with the descending phase, goes the disintegration into simpler sub- 
stances — "corruptio." Viewed as life-principle, we may think of the 
breath as controlling the vegetative faculties of the soul, which are 
associated by an intimate mutual relationship. 

In this connection, the observation may be here noted that 
change of electric potential arising from the metabolism of the salts 
is necessary to the formation of active (as opposed to inert) fat in the 
body. 

Hence physiological action— that is, anatomy in motion — is not 
merely a question of the behaviour of C, H, O, N, S, P, in the various 



i 3 o THE CANON OF MEDICINE 

side-chains, etc. It is a sum of potentialities possessed by the separate 
imponderables and by their varying combinations, in the particular 
individual at any given time. The common denominator or^ collec- 
tive formula which represents this sum adequately is necessarily very 
complex, and yet it is really essential that it be elucidated before one 
could be said truly to grasp the real basis of a person's ill -health, 
or intelligently work out the fundamental bases of prognosis. 

5 143. (i'i) The activity of movement. — The second mode of 
activity of the breath consists of a cyclical movement, a movement in 
place, a movement comparable with a circulation. During the 
course of this movement, the breath comes successively into relation 
with the several tissues and organs, one after the other until it re- 
appears at the starting-point. 

The movement may be anti-clockwise as well as clockwise in the 
various parts of the body. 

But there are two paradoxes here. Firstly, there is no 
period of time when the breath can be said to have passed a given 
point. It is not like an object going round and round, like e.g., an 
imaginarv drop of blood. The breath is all through the body all the 
time. It' is more as if there were a series of lights m an electric 
circuit, and they burning the whole time, but the intensity is changing 
successively from point to point. The breath is always in the great 
centres of the body (the " chakras, pranas "), but it is brightest in the 
liver at one moment, and the brain at the next and so on— yet 
following a certain order.* . 

§ 144. Secondly, the circulation has no anatomical boundaries. f 
Not only this, but it is flowing left-sidedly or right-sidedly. This is 
transparently non-anatomical. Many would reject the possibility 
and even an attempt at proof would be unsatisfying. The justifica- 
tion for the statement that the breath is now left-sided, now right- 
sided, flowing down each side separately, depends on subtle observa- 
tions which are beyond the scope proposed for this work. It will 
suffice to suggest just this : the peculiar attitudes adopted by all 
creatures (animals as well as men) during sleep ; when standing or 
sitting ; when exercising or at repose ; also the different moods 
shown by a given individual — these and similar phenomena, 
carefully watched, furnish adequate indications of the truth of the 
statement. There is also a circulation along such intangible 
" channels " as the temperaments of the organs. 

§ 145. However, there is an actual relation to anatomical 
organs as well. There is no ambiguity about this. The passage of 
the breath from liver to brain, from heart to tissues is orderly, and 
deliberately specified not only in the Qanun but in the De viribus 
cordis, lest the unwary should be misled by the faulty ideas- of 
Avicenna's predecessors and contemporaries. The heart as the 
centre of life, and the seat of formation of the breath, is no mere 

* This was realized also by the Chinese physicians as shown in the Classic on the 
Pulse (vol. lxxx, p. 28) . 

f Possibly this idea underlies the seemingly impossible Chinese statement : the 
blood is inside the vessels, the * spirits ' outside." 



THE CANON OF MEDICINE 131 

fancy. To speak of the flow of the breath through the major organs 
" awakening " each " centre " in turn (cerebral, thoracic, digestive, 
genital) and then necessarily reaching the lesser organs (including the 
tissues and cellular elements) is to give a true picture of life. To 
insist also that in meeting the "centres" the breath is altered; that 
it receives ; and then proceeds in that altered or renewed form to the 
lesser tissues, is to fulfil the great law — the law of giving and receiv- 
ing ; both together ; simultaneous ; balanced in degree. Both are 
true. To omit one is to speak inaccurately because one represents 
only in part. 

§ 146. Application to physiological histology. — As has been sug- 
gested, physiological histology is microscopic anatomy in motion. 
It is the blackboard on which can be demonstrated the reality of 
the truths of the scholastic conceptions. So, in studying the tissues 
microscopically we must remember to introduce the conception of the 
flow of the breath through the tissue-spaces, the juice-canals, which 
are also the channels of the breath. Synchronous with this flow 
there is an attenuation of cell-substance into fluids ; and a disinte- 
gration of complex chemical substances into simpler ones. At the 
same time, one must say " the change in the breath is attenuation 
and aggregation of such substances." 

Substances pass from the colloid to the fluid state ; from the 
colloid to the crystalloid state ; from complex to simple ; and vice, 
versa. They pass by _ aggregation from fluids into cell-substance 
(" assimilation "). It is all one single process. That which we see 
with the aid of the microscope is the "visible " manifestation of 
cyclical changes in atom-groups, of carbon, hydrogen, oxygen, 
nitrogen, sulphur, phosphorus, etc. The excrescence which we can 
see on the nuclear contour of the leucocytes, for instance, is this 
dominance of the several chemical elements — whether the change be 
the outcome of " attenuation " or of " aggregation." Not onlv this 
but the excrescence of the nucleus is also the effect of the change in 
the breath which at different times belongs to different chemical 
elements, and so to different morphological histological appear- 
ances. 

The conception of the blood-forming centres as the meeting- 
point of two vitalities has already been suggested (§ 121). 

§ 147. Application of the conception to pathology, (a) Disease 
as the result of interference with the freedom of flow of breath, not 
only round the body, but also away from the body altogether. — It 
is clear that an actual obstruction in a tissue (whether it can be seen 
with the naked eye, or felt with the hand, or whether it is in so minute 
a channel that the microscope is needed to demonstrate it) prevents 
the flow of tissue-fluids and is the forerunner of a morbid condition — a 
" disease." But it exerts this effect primarily because the flow of the 
breath is obstructed and its rhythm degraded. Could the two series of 
events occur independently, the fact is that the former, the material 
obstruction, would not suffice to set up such a morbid condition. 

The following are useful concrete examples of diseases produced 
in this way : 



I3 2 THE CANON OF MEDICINE 

The dire effects produced by hysterectomy in young persons, 
once in much vogue for instance for severe dysmenorrhea ; and the 
persistent ill-health which appears when it is done in older persons 
round the prime of (child-bearing) life. The explanation is to be 
found in the destruction of the "channels" of the breath— the 
severance of non-medullated nerve-fibres, and even the actual removal 
of important nerve-ganglia. This indefinable vital component of the 
being which must '"' circulate," goes so far, and then finds a void, and 
its activity is turned back on itself ; there is a revulsion ; and the 
patient is aware of a great distress which nothing will (or can) 

relieve. . . c 

(ii) Jejunal ulcer following gastro-enterostomy, or excision ol 

gastric ulcer. ' . 

(b) Disease as a result of disturbance in the rhythm of the breath. 
A change of rhythm, or an ataxy of the breath, would suffice to 
initiate a loss of immunity to bacterial agents. Since there must also 
be an outflow of breath, any associated interference with its current 
would have the effect of holding back any of the isolated micro- 
organisms which are always to be found in the tissues.* 

In this way the organisms would have time to develop into active 
colonies. Structural organic changes then appear in the body. 

When Paracelsus said that " life-principle may decompose and 
become a strong poison, furnishing life to innumerable, invisible 
(i.e., microscopic) existences, by which infectious diseases are caused, 
he was not speaking foolishly. 29 (p. 155)- 

(c) Loss of balance between the normal qualities of the breath and 
the functions of the body may initiate disease. 

(d) The relation between the intracorporeal cycles of the breath 
and the cycles in the outer world is a factor for consideration in regard 
to the study of bacterial cycles in Nature, outside the bodies of animals 
and other human beings. . 

(e) Sudden recovery from incurable diseases should be intelligible 
in view of the nature of the breath. Remembering the existence of 
polarity, and a point of penetration into the corporeal being, and 
considering the fact that in disease there is a distortion of the shape 
of the breath, it is not difficult to conceive that some outer force or 
power breaks through and restores the polarity to normal, in which 
event the sick person would be once more in proper relation to bis 
terrestrial conditions, and be freed from the interference (analogous 
to the interference of light) which has previously occurred in the 
activity of the breath. The event of such a revulsion occurring at 
all whether the subsequent physical recovery be instant or only 
reached by gradual stages, would bring the case within the category 
of miraculous cure. . 

S 148 —Changes of quality of activity of the breath are simul- 
taneous with its movement from place to place within the body.— 
The two aspects of the activity of the breath must be considered 
simultaneously, for they are not actually separate. Thus, to sum up, 

• This fact was again called attention to recently by Sir Charles Ballance. 
(October, 1929; Lancet, 1929, 324-) 



THE CANON OF MEDICINE 133 

we picture the breath circulating from nutritive organs to those 
of the sensitive life, awakening as it does so the lower passions 
(the nutritive = " appetite " ; the reproductive == " desire " : see 
•§ 160 ; and then the higher (the emotions, the " atmosphere," 
the " inspiration "). The faculties of each organ are " activated " 
as the breath traverses them ; their vitality augments, and the 
breath itself concurrently receives something from each " centre." 
The " natural " breath is the phase, then, when the breath is con- 
sidered in regard to the natural or vegetative processes of the body, 
and is ''located " in the liver, and is associated with venous blood'. 
The " vital " breath is the phase when it is located in the heart, and 
is associated with arterial blood. The "animal" (or sensitive) 
breath is associated with the nerve -fibres. Yet there are not three 
breaths, but one breath — " not three souls but one soul." And the 
" breath " is not the " soul." 

The changing activities of breath are associated with changes in 
the composition in regard to the cosmic elements ; with changes in 
chemical composition. Movement of quality (type, rate, primary 
quality) goes with movement in regard to place. 

The expressions "a matter-of-fact person"; an "emotional 
person " ; a " neurotic person," in the light of the considerations 
presented at such length, are seen to be capable of interpretation in 
terms of corresponding types of " breath," which are dominant in 
the given individual (§ 138). 

§ 149. All these changes have been analogized with a "dance." 
The_ breath is the controller of both aspects of the dance. It is the 
music of the dance which holds the dancers together. When the 
music ceases the dance ceases, or degrades into a meaningless 
disorder. _ And the ceasing of the dance is ' death' ; and the 
degradation is the subsequent decomposition processes. 

The player of the music, and the movements of the two dancers 
should blend harmoniously to make the perfect dance. What if there 
be inattention on the player's part ? What if he should not corres- 
pond to the capacities and capabilities of the dancers ? What if the 
giving and receiving between the music and the dancers should fail 
at any moment ? Surely, then there is di'sease. Whatever modern 
medicine has to say about etiology, this fact remains at the root of the 
phenomena of all disease. In health, the dancers depend on the 
player, and their dance is so perfect that they always respond to his 
tune. But there comes the time when the (hidden !) Improvisor of 
the music cries out " Halt ! " 



I34 THE CANON OF MEDICINE 

§ i 5 o.— The following repetition of some of the important facts so far discussed 
is iustifiable for still greater precision. 

j Abbreviations : a, animal ; 6, breath ; B, body as a whole ; C vital centres 
(heart, liver, brain, gonad) ; /, faculty; h, heart; j, vegetative ; I life ; i, 
life-principle ; w, mind ; «, natural ; r, rational ; s, sensitive or sentient, or sensuous , 
5, soul in the Platonic sense ; sp., spirit, v, vital. 

(a) General Statements : — 

7_ exhibits jf, sf, rf, and vf. 
But L is not the same as ;/, sf, rf, and vf ; or the same as (;.s.) /. 

L is not = jf+sf+rf+vf. 

L is not the same as S. 

S is not the same as L ; or m; or sp. 

S includes L, b, jl, si, rl, vf. 

b is not I, or L, though almost equivalent to I. 

I implies b. „ . _ , , , . , . . 

of (Avicenna) belongs within the domain of sf and rf (scholastic). 

jl (scholastic) comprises vf and nf together (Avicenna) 

si (scholastic) comprises vf, nf, and some af (Avicenna). 

si (scholastic) is equivalent to nf. vf. {af—rf) (Avicenna). 

rl (scholastic) comprises vf, nf, af (Avicenna). 

rl (scholastic) includes jl and si (scholastic). 

(b) Special Statements. 

(i) The three chief views of the nature of a person are : 
Modernist, or scientific or rational : ^ + "?- „ c , D 

Popular or Platonic. f and B, or &+£. 

Aristotelian. S.B., orSX-B. 

(ii) The scholastic view may be thus expressed : „ . , x »» 

" Nature " is L.B. ; the '* vegetable nature " is jl.B ; the animal nature 
is jl.sl.B ; " human nature " is jl. si. rl. B. . 

(iii) Comparing the description given by Avicenna, with that given by 
S. Thomas, we have : 

Avicenna (&.«/■ a D- B (Q 

S. Thomas -f-B ; or (;/, 5/, rl) B 



5. The Animal Faculties (Sensitive Life) 

174. The animal faculties comprise those of (a) perception 
(b) locomotion. The former comprises (i) external senses, (ii) 
interior senses. Each of these exhibit five faculties. 

" Now the ' Perceptive faculty ' (Mudrika) is subdivided into ten branches 
five of which are called the External Senses,' and five the ' Internal Senses ' TW 
former are Touch, Taste, Sight, Hearing, and Smell "— (Ch M ') 

These faculties may be also designated faculties of the lower mind or lower" 

+A ," + Au S ust f e says that the higher reason is that which is intent on the con- 
templation and consultation of things eternal ... but he calls the lower reason 
that which is intent on the disposal of temporal things. Now these twc^namely 
eternal and temporal-are related to our knowledge in this way, that one of them 
is the means of knowing the other." (. . p. r I2 ) .^The whole subject is to be found 
treated in a masterly manner in this and adjoining sections of that work. 

175„_ A division of external senses into eight is obtained 
by regarding " touch '' as including four senses in itself, for this 
is performed by more than one organ. Thus the tongue not only 
tastes but has a sense of touch. This view follows the philosopher. 

4 JtT S tT eS are ,£°* fu £ ther discus sed in the Canon. The following quotation 
from Chahar Maqala (E. G. Browne's translation') may be therefore addld 

Hearing is a sense located in the nerve which is distributed about the auditorv 
meatus, so that it detects any sound, which is discharged against it by undulations 
of the air compressed between two impinging bodies, that is to say, two bodies striking 
against one another, by the impact of which the air is thrown into waves and becomef 
the cause of sound, m that it imparts movement to the air which is stetionarT'n 
the auditory meatus comes into contact with it, reaches this nerve, and gives rise 
to the sensation of hearmg.-S^ is a faculty located in the opt c nerve which 
discerns images projected on the crystalline humour, whether of figures orTolid 
bodies, variously coloured through the medium of a translucent substance which 
extends from it to the surfaces of reflecting bodies—Smell is a faculty locatelin a 
protuberance situated m the fore part of the brain, and resembling tte nipjle 
the female breast, which apprehends what the air inhaled brings to it of odours 
mingled with the vapours wafted by air-currents, or impressed up^on it by diffusion 

J r T^ ° + d0n ^ C J?° dy -r • K 1S really a ver y delicate ^nd of taste. The sense of 
taste detects soluble nutriments in those objects which come in contact with the 
tongue, discriminating between sweet, bitter, sharp, sour, etc. The sense ™ 'touch 
is distributed throughout the skin and flesh of the animal, the nerves Serebv 
perceiving and discerning anything which comes in contact with them— such as the 
four primary qualities: dryness, moisture, heat and cold; and the secondary 
qualities of roughness, smoothness, harshness, softness beconaary 

^ * , sounds > the five tastes, the five colours, are simply manifestations nf 
the five elements (cf Forks-, p . m , •• Your t&s ^ 3^^™ youi hea?Lg 

etc.— these are the elements ; so say not they exist not ! " wearing, 

176. The Interior Senses.. — 

There are five groups of interior faculties : the composite 
the imagination, the apprehensive or instinct, the retentive or 

-35 



136 THE CANON OF MEDICINE 

memory, and the ratiocinative. The first two are taken together 
by the physician, but not by the philosopher. 

177. The 'Composite sense ( = Common sense: Hiss-i-mushtarik) 
is that which receives all forms and images perceived by the ex- 
ternal senses, and combines them (into one common mental 
picture). 

Site : Anterior Ventricle of Brain (Ch. M.) 

The sensations of sight, smell, touch, afforded by an object 
are conjoined, and the qualities perceived by the different senses 
become gathered into one single percept. This faculty' exists in 
virtue of the fact that all sensation and muscular action are two 
aspects of one process. With the exercise of every sense-organ there 
goes an exercise of muscular action, and the latter cannot occur 
without at the same time arousing muscular sensations, because 
sense-organs for muscular senses are everywhere present along the 
fibres of which the muscles are composed. 

178. Imagination. — (Phantasy.) This preserves the per- 
cepts of the composite sense after they have been so_ conjoined, 
and holds them after the sense-impressions have subsided. The 
common sense is the recipient and the imagination is the pre- 
server. The proof of this belongs to the philosopher. 

The chief seat of the activities of these two faculties is the 
anterior part of the brain. 

§151. Regarded from the scholastic point of view, the imagina- 
tion maybe distinguished into (a) sensuous, (b) rational, ox intellectual 
The former is equivalent to Avicenna's term, for it concerns itself 
with natural objects. The second form is concerned with ideas, is 
creative or productive, and manifested as " invention " (artistic, 
mechanical, scientific, etc), whereas sensuous imagination is simply 
reproductive. But in both cases the faculty is defined as " the power 
of forming mental images or representations (" phantasms ") of 
material objects apart from the presence ofthelatter " (Maher, p. 163). 

Source of the images : (a) the sensations, emotions and actions of the body ; 
(b) trains of thought, which are chiefly on the higher plane of rational life ;. (e) the 
intellect ; {d) other external influences, such as other minds, whether human or 
angelic. 

The difference from " common sense " is that the latter only 
deals with objects while present. 

179. The Cogitative Faculty. — The faculty which medicine 
calls cogitative is taken in two senses in philosophy.. It is regarded 
sometimes as "imaginative faculty'' [mutakhayyal : animal] 
and sometimes as " cogitative faculty" [mutafakkira : human]. 



THE CANON OF MEDICINE 137 

In the view of the philosopher, the. former is where the appre- 
hensive faculty (q.v.) comes into play, and the latter is where 
reason controls or decides that a given action is advantageous. 
There is also the difference that the imagination deals with sense- 
form percepts, whereas the cogitation uses the percepts which have 
been stored in the imagination and then proceeds to combine 
and analyse them, and construct quite different images : e.g. 
a flying man, an emerald mountain. The imagination does 
not present to you anything but what it has already received 
through the sense-organs, (p.) 

The seat of this faculty is in the mid-portion of the brain. 

It combines or separates, as the mind selects, those particular percepts which 
are stored in the imagination. 

It is clearer to place the cogitative faculty into the higher " plane " of rational' 
life. It really belongs partly to the intellectual imagination, and partly to the 
rational faculty, the understanding. 

180. The apprehensive faculty. — This faculty is the in- 
strument of the power called instinct in animals. ^Animal 
prudence."*) By it, for instance an animal knows that a wolf is an 
enemy, and the kid distinguishes its dam as a friend from whom 
he need not flee.* Such a decision is not formed by 
the reasoning powers, but is another mode of apprehension. 
Friendship and enmity are not perceived by the senses, nor do the 
senses comprehend them ; and they are not perceived by the 
reason either. Man employs the same faculty on very many 
occasions exactly as does an irrational animal. 

Apprehensive faculty v. imagination. — The former executes 
a judgment ; the latter simply stores sense-perceptions. 

Apprehensive faculty v. cogitative faculty.- — The former relates 
to one single act ; the latter does not make a judgment, but 
opens the way to a series of discursive processes and decisions. 
The cogitative faculty is concerned with the synthesis and 
analysis of sense-impressions whereas the apprehensive faculty 
makes a judgment on the super-sensuous ideas in the particular 
sense-percepts. The cogitative faculty is concerned with forms 
perceived by the senses ; the apprehensive faculty deals with 
derivatives therefrom (" suprasensuous forms.") 
^ ] Some writers however call the apprehensive faculty " cogita- 
tive " as a matter of convenience, saying that the terms are 
unimportant as long as one understands the things themselves 
and the primary differences between them. 

*Or, as a child distinguishes between a spotted rope and a serpent, and dis- 
covers the suprasensual ideas existing in particular percepts. (Ch. M.'). 



138 THE CANON OF MEDICINE 

§ 1 52. Clearly, the apprehensive faculty of the text covers both 
"lower reason" and "reason" as ordinarily understood. The 
former is also called " instinct." The difference between the two is 
easily defined in theory, but difficult to apply in practice. _ Instinct is 
"the sense of what makes for the well-being of the individual." 
" Concrete relations are perceived without an abstract conception 
being formed. Instinct therefore differs from reason in the absence 
of abstract universal knowledge. At either end of the scale, the 
external manifestations are clear and absolute." 50 

§153 Instinctive actions may be described as highly complex reflexes, 
the movements being spread over a (variably) long time-period, and appearing 
after a (variably) long interval. Thus we have : 

(a) sensory stimulus— >lower nerve-centres — immediate reflex movement; 
(6) the stimulus of a perception— >higher nerve-centres — >a series of com- 
plex movements. 
(a) need never reach consciousness ; (&) goes on without a consciousness of the general 
(not " particular ") end or purpose of the movements. 

While the subject of instinct is always discussed in regard to the actions of 
animals it should be admitted that nine-tenths of our daily actions really belong 
exactly 'to the same plane or order. The use of the expression " lower reason 
enables a vast number of particular instances of animal behaviour to be classified 
along with many similar actions performed by man, perhaps especially during 

childhood. . . , . . , , . 

Much of the difficulty about instinct versus reason m animals is avoided in 
this way. It is also to be noted that while speech and language exist in various 
orders of creatures, articulate speech occurs in man alone (Bock 114 ). Animals can 
express their own emotions to one another, and can understand our speech m that it 
conveys emotion. But that is different from the reasoning processes which scholastic 
philosophy limits to man. 

181. The apprehensive faculty need not be considered 
much by the physician because disorders in it are always conse- 
quent on disorders in the prior faculties of imagination, and 
memory, as we shall show later on. It is only necessary to consider 
those faculties the disturbances of whose functions bring on 
disease. It is enough to know that the lesions in one which are 
interfering with the other arise in the temperamental state of the 
member or in depravity of its constitution. For on this know- 
ledge depends the selection of the remedy and how to guard 
against the disease. Not to know about tne state of a faculty 
which is affected only indirectly is of less moment compared 
with accurate knowledge about a faculty which is affected 

directly. 

182. The Retentive Faculty. Memory (Hafiza, Dhakira). 
The power of memory is as it were a treasury or repository for 
those supra-sensuous ideas discovered by the apprehensive 
faculty, just as the imagination is the treasury or repository for 
the sense-impressions of forms and sensible images (formed by 
the common sense). The seat of this faculty is in the posterior 
region of the brain. 



THE CANON OF MEDICINE 



l 29 



The philosopher discusses whether apprehension and 
memory are to be taken together or separately. Is apprehension 
merely a treasury of reflection ? To the physician this problem 
is irrelevant because the same noxa, be it an intemperament or a 
depraved constitution, would affect both and in either case the 
seat of disease would be in the same region of the brain. 

The apprehensive faculty : memory : : common sense : imagination. But the 
composite sense preserves forjns, and memory preserves ideas — the ideas discovered 
by judgment (Wahm). (Ch.M. 7 ). 

§ 154. In scholastic philosophy, the memory is two-fold — 
sensuous and rational. Sensuous memory is the power of retaining, 
reproducing- and recognizing the representations of past experiences, 
and of referring an event to its place in time. The concrete obiects 
of memory under this category are : memory of size, form, position, 
weight, sounds, rhythm, scent, colour, faces, persons and of certain 
events. The degree of capacity for memory in regard to each of these 
varies widely, producing various " types," such as auditory, visual, 
motor, etc. 

The memory of emotional states is called " affective " memory. 

Rational memory, the power of recollection, reminiscence, the 
power of active recall, volitional memory. — This is restricted to man 
(Maher, 50 p. 180). 

183. There is still one more faculty distinguishable in the 
mind, namely, the ratiocinative ; the understanding. Physicians 
do not concern themselves with this any more than they do with 
the cogitative faculty, and for the same reason. They only study 
the operations of the four other faculties. 

§ 155. Charts devised in order to co-ordinate various ter- 
minologies applied to the sensitive and rational faculties. 



u 
bo 



is 
o 



5. Ratiocinative Faculty 



3 . Cogitative 
Faculty 



3 . Apprehension 



4. Memory 






2. Imagination 



1. The Common Sense 



I. Avicenna. 



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The Common Sense 



II. Arabic (Nt. 449). 



140 



THE CANON OF MEDICINE 




III. (Modern) Sufi" 





Thouj 








m 

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O 
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jht (of Goqj 


Reasoning 




Heart : . 


sirr ; qalb ; ruh 


Insight 


Intelligence ( c aql) 


Higher 
Will ; 
Attention 
Hamm 


Concentrating power 


Volition 


CO 

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3 

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: £. 



1 — ' 

rt- 


Judgment 

" The Watcher " 

Wahm 


Reflection 
Cogitative faculty 
Fikr 


1— i 

3- 

0° 


Conduct 


Ideation 


Asso 

Sense- 
memory 


ciation of I< 
Instinct 


leas 
Emotion 


Per- 
cep- 
tion 


Phan- 
tasy : 
Khayal 

Imagin- 
ation 

Musaw- 
wira 


Memory 
(of ideas) 
Dhakira 

Memory 
Hafiza 


Lower 

Will 

Nafs 


Perception 


Stereognosis 


V Modern 139 




Perception 
Mndrika 




(Psychiatric) 




IV. 


Jili 62 (] 


p. r-v 


a 





THE CANON OF MEDICINE 



141 



w 



Understanding 
, Intellect 
Power of thought 



Supra- 
sensuous. 

Imagination 

Sensuous 



Reason 



Instinct 



Supra- 
sensuous 

Memory 

Sensuous 



The Common Sense 



Perception 



VI. Scholastic 60 
Note. — These and innumerable other views regarding the faculties of the 
" mind " are partly accounted for by difference of purpose in view. In ancient 
medicine, everything was related to the cosmic elements ; in modern medicine 
anatomy is all-important. In regard to mental diseases, cortical structure (strata 
of types 'of nerve-cell) is naturally a basis of interpretation. Many modern text- 
books of psychology consider principles of education of the young. Moral phil- 
osophy has another object in view. Eastern mystics regarded the matter in terms 
of the problem of attaining elevation of the soul to God. Standard modern Catholic 
teaching envisages all such aspects, without making clear the links between " theoreti- 
cal " faculties and the actual microscopic anatomy and histological physiology 
of the human body. But these links are the essential interest in this treatise, and 
are outlined in the special chart described and discussed in §§ 157 sqq. 

6. The Power of Locomotion 

184. This power is that which contracts and relaxes the 
muscles whereby the members and joints are moved, extended 
or flexed. This power reaches the limbs by way of the nerves and 
there are as many forms of power as there are of movement. 
Each muscle has its own peculiar purpose and it obeys the decree 
of the composite sense. 

§ 156. That the soul is endowed with a locomotive faculty is simply an 
ultimate fact. Our life-long experience assures us that mind and body do interact 
but how we cannot tell. (Maher 220). 

The skeletal system is the instrument of animal life. 

Movement occurs in plants, but so slowly that it was not positively discerned 
till recent years, and is not a " locomotion " (see § 128). 

7. The Functions (of the Body) 

185. Some of the functions are carried out by one single 
faculty ; others by two together. The former is exemplified 
by digestion, the latter by the appetite for food, where there is 
(1) the vegetative faculty of attraction, (2) the faculty of sensation 
located at the mouth of the stomach. The faculty of attraction 
is achieved by a contraction of the longitudinal fibres which 
draw the object inwards and extracts from the humours that 
which is required. The faculty of sensation enables the organ 
to be aware of the acridity of the atrabilious humour, for this 
it is which excites appetite. In saying that this one function 



1 42 THE CANON OF MEDICINE 

is achieved by two faculties together, one relies on the fact that 
a nocument befalling the, faculty of sensation destroys that 
" desire " which is called hunger and appetite. Even the need 
of nutriment does not account for " desirei" 

186. The function of swallowing is another instance of a 
dual faculty' — that of attraction and that of propulsion. The 
faculty of attraction is achieved by the longitudinal fibres at the 
orifice of the stomach and oesophagus ; that of propulsion is 
achieved by the voluntary muscles of swallowing. Loss of either 
power renders deglutition very difficult ; even retarded activity, 
without actual loss, renders the act. difficult. Every oneknows 
that lack of appetite for a substance makes swallowing difficult. 
If a thing is repugnant, and yet we wish to swallow it, our appetite 
and power of attraction is so frightened away that the function of 
voluntary deglutition is made difficult. 

187. The function of transmission of nutriment along the 
alimentary tract is achieved by the faculty of propulsion forwards 
of the portion containing the nutriment. It is associated with the 
faculty of attraction exerted by the succeeding portion. 

188. The discharge of 'waste matters is also a two-fold 
function. Sometimes both sensitive and vegetative faculties 
initiate the function simultaneously. 

189. In some cases a faculty is associated with a quality. 
Thus cold holds material, and also arrests the flow of humour (or 
intestinal contents^ either absolutely by repressing its formation 
or relatively by driving it back. Cold restrains by (i) congealing, 
the material (rendering its particles closely aggregated), or (2) 
narrowing the pores. Incidentally it has a third action — (3) 
that of obliterating innate heat (which is concerned with the 
faculty of attraction). 

190. Heat. Heat attracts by the ways already mentioned. 
Heat and the urge occasioned by (relative) vacuum first attracts 
the attenuated matter, and later the denser matter. The vegeta- 
tive faculty of attraction only attracts the things most appropriate 
for it, or things whose nature it is to be attracted. Consequently 
it might happen that the denser (more concentrated) matter, being 
more suitable and appropriate, and responsive, is attracted first. 




Mouth . . 



Stomach . . 



Small Intestine 



Liver 



Choicest ingredients 

completely become 

BLOOD (SANGUINEOUS HUMOUR) 

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(THIRD DIGESTION) 



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Bile (q.v.) 



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to 

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I 
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2. Skin: insensible perspira- 

tion, hair, nails, sordes of 
lips and skin 

3. Tissues: obesity, fibrosis of 

conn. tiss. ; neuritis (Beale, 

P- 59) 

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The Correlation of the Various Faculties. 

(Summary and extension of Thesis VI.) 

§ 158. The correlation between the various faculties with the 
mter-connections between the visible bodily organs is usefully 
indicated by means of a suitable map or chart. 

The following considerations are necessary in studying 
the accompanying map. (1) There are no actual boundaries between 
the faculties, even in the case of the discrete viscera. The internal 
senses are " merely diverse aspects or phases of a single sensuous 
faculty (Maher, 50 p. 96) as Aristotle perceived. To name 
departments " of the mind, it must therefore be constantly remem- 
bered, is simply to help the memory, and assist analysis of the various 
mental operations. (2) Subdivision of faculties into " animal " and 
human " is to be avoided. (3) The enumeration of mental faculties 
given by phrenology is not vitiated by the fact that phrenolookal 
charts are not anatomically correct. (4.) Since the strength ofone 
faculty involves a corresponding weakness of some other, even the 
very existence of the faculty may. be virtual. 

§159. Brief. Description of the Chart. 
Six discrete " planes " are represented, and are named according 
to certain terms selected from those used in various classifications 
1 he vertically placed plane serves to indicate a close relation between 
this and each of the horizontal ones. 

Plane I.— This refers to the vegetative life, and shows the various 
organs and their mter-connections, as well as their relations to the 
superposed planes. Connection with the lower extremity of the 
vertical plane indicates the existence of " unconscious appetition " 
in this sphere of life. This, the so-called "natural appetite," is 
defined as the inclination towards a thing which is in concord with 
its nature, without any knowledge of the reason why such a thing 
is appetible "» (I, 656). It is inherent in the nature of " beine " 
on this plane. fe 

. Appetite is (a) natural (hunger, thirst, sleep, exercise, sex) lb) sensitive (reflex 

nrt ret^U C) Cll°Z L T^ tW ° *%*" ^ ° n °^ ic coniitionTwhich are 
not regulated by reason. The sensitxve appetite is under the control of the will 
and can be strengthened or checked thereby. 1 ' (i. 656). Appetite in the sen Z of 
sinful de S1 re, belongs to another aspect of the subject. A PP etlte < m the sense of 

Plane II — This refers to the sensitive life. Sensitive life 
comprises the power to know " (i.e., the faculties already discussed 

143 



i 44 THE C AN0N 0F MEDICINE 

in 176-183 of the Canon, and shown in the charts in § 155), and -the 
"power to love "(= " appetition " = "the power of loving that 
which is the good for the individual" = appetitive faculty = desire). 
The power to know is represented by Plane II and the power to love is 
represented by the lower part of the vertical plane. ..Both find 
their realization in organs depicted on Plane I. 

"Lower" is used as equivalent to "animal" (as opposed to human) Scholastically 
it is the antonvm of " higher." " Reason," again, is made equivalent to instinct 
because popularly the latter word is taken to be the same thing as automatism. 
In scholastic philosophy the phenomenon of instinct is appraised properly. Hence 
"lower reason " comes to be applicable for a certain series of phenonena for that 
which scholasticallv is called instinct is that which m modern life is called lower 
reason " The word reason should however be applied strictly to those higher 
operations which scholastics define with masterly precision. 

Coincident with the mental representation of the thing— whether 
it be good or evil for the individual— there is an agreeable or dis- 
agreeable passive state of consciousness,, and this is called an 
"emotion." Emotions are subdivided into " concupiscible and 
" irascible " The former imply attraction or repulsion, and are : 
love, hatred ; desire, abhorrence ; delight, sadness. The latter 
concern the sense of self-preservation. They are : hope oi ac- 
quiring an object which it is difficult or dangerous to obtain ; 
despair of so doing ; fear of a threatening evil or danger, with 
impulse to flee ; courage, when there is an impulse to remain ; 

anger. . ,. . 

The objects of each of these emotions are : concrete objects, 
whether inanimate or living ; muscular activity ; experience 
(excitement, adventure) ; emotion itself. For example, there may be 
fear of hunger, cold, lack of necessaries of life (clothing, etc ) ; ot 
illness; of death ; of punishment, of reproaches, of tears ; of loss of 
prestige or reputation, of being misjudged or considered eccentric ; 

fear of failure. . _, 

Planes III and IV together refer to the rational lite, iney 
appear separated in order to bring out the idea of active and passive 
intellect They stand for: the " power to think." The vertical 
plane belongs with these two planes as representing " the power to 

W1 ' The power to think, or Understanding, is regarded as two-fold— 
speculative and practical. The former, under the influence of the will 
produces the act of contemplation, the object in question being purely 
ideal (poetry, music, art, refinement, taste). It sees resemblances 
sees the " simolicitv " of creation, and makes even the most thorough 
difference seem quite secondary and insignificant. It includes 
foresight, research, " wisdom." The practical understanding, under 
the influence of the will, and by the use of the physical body, accom- 
plishes constructive work. 

"The power to will, or " rational appetite," precedes voluntary 
movement. The inclusion of the terms " attention," ' conscious- 
ness," " heart," " ego," on the vertical plane, is for convenience and 
• does' not imply synonymity in every respect. 



THE CANON OF MEDICINE 



H5 



Plane V, as representing the " supernatural " life, is only 
introduced for completeness, and its relation with the " lower " 
planes, though intimate, is purposely not specified. Its necessity was 
perceived by Jili (taken as a representative of Islamic mysticism, by 
Nicholson 62 ) when he discusses the " perfect " or " ideal " man, and 
some of its features appear in the chart representing his views (§155). 
The subject belongs primarily to theology. 

§ 160. — Details regarding the Emotions. 

(1) It will be seen that there is no separate account of the 
Emotions in the Qanun. They are only referred to incidentally, 
except in the chapter on the Pulse (601) which describes the effect of 
five particular emotional states on the Pulse. 

(2) While classification of the emotions is unsatisfactory as 
Mali- 5 " --■ ' ' ■" ' • " - ■ • J ' 



er 



points out, the short list given by Avicenna is convenient 
in practice, because every patient may be regarded as fundamentally 
governed bygone or other, the others being relatively unimportant. 

In this section such emotions as aesthetic and moral feeling are 
not considered. The self-regarding emotions are referred to under 
" Ego " (§ 164, IV). 



(3) 


Emotions and Their Correlations. 






1. 


II. 


III. 


IV. 


V. 


Latin name 


Gaudium 


Laetitia 


Tristitia 


Ira 


Timor 


Arabic name 


Surtir 


Lazzat 


Gham 


Ghadab 


Faz 1 


Chinese name 


Hsi 


Ai 1 


Ai 


Nu 


Chii 


Translation 


Joy 


Delight 
Concupiscence* 


Sorrow 


Anger 
Hatred* 


Fear 


Corresponding 
Element : 
Sufic 
Chinese} 


Aether 
Fire 


Air 
Earth 


Earth 

Metal 


Fire 
Wood 


Water 
Water 


Corresponding 
phase of breathf 


Jelal 


Jemal 


Jemal 


Jelal 


Jemal 


Dominant 
Humour 
corresponding 


Sanguineous 


Sanguineous 


Atra- 
bilious 


Bilious 


Serous 



(4) Relation between the emotions and the " elements." — There 
is not a strict relation between individual emotions and individual 
elements. As has been explained, all the elements occur together, 
though one may be said to be more frequently dominant than another. 

* The Chinese speak of seven chief emotions, concupiscence and hatred being 
the two additional ones. Instead of "delight," "liveliness," and "love" are 
equivalents of " ai 4 " 

f In theosophical language this relation is expressed by saying that emotions 
belong to the astral " plane. 29 (p. 167). 

I Su-Wen (Forke 23 ; Wieger 141 ). 

L 



I4 6 THE CANON OF MEDICINE 

The same applies to the phases of the " breath "-the degree of 
vitality. Every emotion goes through three phases of activuy- 
risfngf acme, falling,-as do the types of breath Hence different 
words are required to describe each emotion according as it is weak, 
strong, balanced, pure or mixed. (See §139, § 164, 11 ; ). 

This complexitv is illustrated by the following mstance-the 
relation- between "anger" and «>«.»--" Fire varies from dull 
smouldering to a red-heat, and so to flame— flicker, lambient, gentle 
pTle uriZ sudden flare continued light of different degrees of 
fnteAsitt, fierce burning, ferociousfire. The phrases : one's blood bois, 
he flared up,-and so on, are graphic enough. Actually the vessels 
engorge, the muscular power is intercepted the mind becomes 
confused ; the bile is set in motion, and may be expelled from the 
gall-bladder, leading to relief (bodily as well as mentally), or enters 
the blood more freely, engendering heat and increasing both the 
acid and the bitter throughout the body. Whether a person is 
irascible, or is difficult to rouse to anger, whether the passion will 
smoulder (and hence show as a resentment, and spirit o ve •ngeance) 
will depend on whether the humours are mixed or whether one or 
other is definitely preponderant in the resting state 

An angry person gives out a definite atmosphere a feeling of 
beine "on edge." The effect on bystanders depends on their 
dominant emotional state ; in some it provokes quarrelsomeness m 
others perplexity owing to the discovery that the person is unapproach- 
able Silence and appropriate interior exercises are indicated. 
Angry words produce mental " sores " ; they may heal, or they may 
be kept goingf or they may be re-opened, or become incurable. 

An outburst of anger may be provoked by a clash of interests. 
Thest vary widelv. Thus, two wills may clash ; the function of one 
organ ma clash with that of another (e.g. menstrual irritability or 
outbSrste of temper); clash of duty with self-wilL The intensity of 
the outburst is according to the principle of jelal-jemai. 

Anger may be manifested as a " liver-storm (variable dura- 
tion^ "storms " from stagnation in connective-tissue spaces (longer 
duStion) "^erve-storms " (short duration), " mind-storms (lead- 
ing to criminal acts). These phenomena may come onu«. 

CO Physical effects of emotional disturbance,- 1 he ettect 01. 
anger on bodily functions has been referred to. Fear may ^manifest 
as lastric trouble, indigestion, constipation. Panic-fear may provoke 
dLSSa and polyuria. The blood becomes flooded with toxins, 
and the kidneys are taxed in consequence. 

The blood-state is altered during the sway of emotions (Cf. 1090.) 
The blood-cell formula may also alter. 

The humoral formula changes during emotional phases but there 
is no rigid relation to be assigned. Those given in the table are not 
absolute. 

Analysis of a total emotional process. -Viewed as a complex process, the following 
compote^St considered fn «^^^^^^^- : } £ ^ 



THE CANON OF MEDICINE 147 

process along motor nerves (b), (iii.) bodily commotion caused by ii. -f b ; this 
reaches consciousness through sensory nerves (c). Psychically, the emotion is 
made up of i + ii. + iii. ; physically it comprises a + b + c. (After Maher, 5 °, p. 446) . 

§ 161. — Details concerning some of the Faculties and 
Phenomena pertaining to Rational Life. 

The term "Mind" is variously defined. It is taken as synony- 
mous with (a) intellect ; (b) intelligence ; (c) consciousness, conscious 
intelligence ; (d) the nervous system ; (e) the brain (thus, behaviour- 
ists employ " mind " for " brain " from a dislike of the materialistic 
sound of that word 156 ) , (/) the entire psychical being. It is defined 
as (i) a sum-total of the mental processes (Howell's Physiology) ; 
(ii) that which thinks, feels and wills ; (iii) " the terminus of 'an 
evolutionary progress from reflex and tropism by way of memory and 
imagination to intellect and reason " ; (iv) " mind is to be interpreted 
in biological terms, as an organism, an organ of adjustment, 
a structural fabric " (Purposive school of psychology). 156 " Mind " 
is analogized with a room, in which the soul lives ; with a 
mirror which reflects every thought coming into it. The purpose of 
this analogy is to illustrate differences between individuals just as 
there are different kinds of rooms, styles of decoration, coloured 
windows. 

The scholastic definition of the mind is that it is the proximate 
principle of understanding, and designates rational life as opposed 
to sense-knowledge. Mind is not a special power over and above 
the memory, intelligence, and will, but is a potential whole comprising 
these three. It includes all those powers which in their operation are 
entirely removed from matter and from material conditions. (St. 
Thomas, Quaestiones Disputatae, De Veritate, x. 1 ; and ad 12 ; 
Sum. Theol. 77, a. 5.) 

Activity of mind. — This may be considered in three aspects : 
mobile, rhythmic, and chaotic. The former is shown in gentleness, 
generosity, gratitude, goodwill, easy-going disposition. Rhythmic 
activity is shown in reason and logic ; in business-like character ; 
moderation in love and hate, likes and dislikes. Chaotic activity is 
shown in intolerance, suspicion, imprudence. 

A. The Intellect. (Plane III, IV). — The active intellect is defined as the 
power of abstracting, whereby the object obtained by the senses (the image stored 
in the imagination) is disengaged from its individual conditions and rendered in- 
telligible. It " abstracts from the representations of concrete things or qualities, 
the typical ideal essential elements, leaving behind the material and particular "" 
(I. 74), " manipulating them like algebra without immediate reference to the con- 
crete." It considers things apart from quantity, quality, place, and time. 

Relation of intellect to corporeal organs. — intellect is a function of the mind 
alone ; it is not exerted by means of any organ (Maher 50 , p. 239, 240). Intellectual 
activity depends extrinsically, or per accidens, on the organic faculties, as the school- 
men said (ib. p. 241). Intellect is a spiritual faculty. 

Whereas sensations of touch, or phantasms of colour are possible only to 
a soul that informs a body, and can only be elicited by modification of an animated 
system of nerves, intellectual judgments are not the results of a stimulus of a sense- 
organ, but are products of purely spiritual action. " The inferior mode of mental 
life is awakened by the irritation of sentient nerves, the superior activity is due to a 
higher reaction from the unexhausted nature of the mind itself ; and the ground 
for this reaction lies in the fact that the same indivisible soul is the root of both 
orders of faculties." (ib. p. 242). 



i 4 8 THE CANON OF MEDICINE 

B. Perception. Imagination. — These are shown on both the II and the III 
plane. (Cf. § 155)- " 

C. Concepts v. Images. — The formation of concepts must be distinguished from 
that of ' phantasms, or images. the concept is a representation of objects of a 
class ; the image pictures only one particular colour, shape, size, etc. The concept 
is fixed, immutable, and has no relation to time. The image is unstable, contingent, 
and fluctuates. The concept represents the nature or essence in an abstract con- 
dition, " ignoring or prescinding all accidental individualising conditions." " The 
image' reproduces the object clothed with these concrete determinations." (lb. p. 

237). 

D. Thought. — This cannot be called a " sensation, "as shown by the question 
raised by Balmez (quoted in Maher, p. 243) : " Is the perception of the difference 
of the smell of the rose and that of the pink a sensation ? If we answer that it is 
not, we infer that the judgment is not the sensation transformed, for it is not even a 
sensation." 

The mechanism of thought. — " The external objects stimulate the senses and 
effect a modification of the sensuous faculties." The result is a sensuous percipient 
act. " A sensuous phantasm arises in the imagination. The intellect now acts 
and abstracts the essence, thereby generating the concept which expresses ( the 
essence of the object. This abstract concept is then viewed by ' reflection ' as 
capable of representing any member of the class. A formally universal idea is now 
constituted " s0 (p. 311). " By comparison, reflection and generalization, the idea 
is elaborated till we attain to the distinct and precise concepts or ideas which accurate 
science demands" (Maher 17 : vii. 633). 

E. Reasoning. — This is defined as a process in which a succession of cognitive 
acts representing the various " notes " of a thing are unified, through relations 
being established between them. It is the opposite process to intuition. By 
intuition, one single act conveys all that can be known of a thing. The faculty 
of reason seeks new and differential characteristics. The most minute differences 
are essential. It includes : discerning power, sense of discrimination, classifying 
power, sense of proportion ; observing power for (a) things, to see analogies and 
resemblances between them ; (b) persons : e.g., character reading ; (c) ideas, which 
link this faculty to that of the intellect. It also includes the attributes of order- 
liness, method, sense of absurdity, and therefore merriment, humour, wit, sarcasm, 
ridicule ; curiosity, mimicry, character-interpretation as by actors ; arguing, and 
reasoning power pure and simple. 

F. Intuition, or intuitive knowledge. — This term is variously used. In the 
present volume it is intended to refer to a particular kind of knowledge obtained 
through the use of the intellect, as applied to many of the topics of medicine. 
That which is called esateric knowledge, or "wisdom," may be included under this 
heading. Foresight, so-called mystical interpretation, insight are obtained by the 
nse of the intellect influenced by mature experience. In medicine, as well as in daily 

life, we may 

" Look with spirit-eyes, and lo ! shall see 
Glory in everv leaf o'erwaves the head." 

(Night 94 ; Burton ii. 39). 

" The spirit of faith is the habit of seeing everything in God, and God in 
everything." F r - Plus. 

From the Scholastic point of view, the following are proper propositions : 

(1) All knowledge begins in the data furnished by sense-experience. 

(2) Primarv principles are known by intuition. 

(3) Abstraction and discursive reasoning are the instruments wherewith 
we discern the nature of the data of sense-experience, their laws and causes. Through 
these two servants of intuition the mind gains a scientific and philosophical knowledge 
of things (Sum. Theol. i. 58, a. 3 ; II-IIa. 49, a. 5, ad 2m.). Through the same two 
servants of intuition we arrive at the notion of immaterial beings and of God Him- 
self" (i. 12) » (1, 84-88). 

(4) " Concepts and reasoning, therefore, are in themselves inferior to intuition ; 
but they are the normal" (i.e., usual, or most widespread) "processes of human 
knowledge." 

" For the Schoolmen, the intuitive act of intellectual knowledge is hy its 
nature the most perfect act of knowledge, since it is an immediate apprehension 
of and contact with reality in its concrete existence, and our supreme reward in the 
supernatural' order will consist in the intuitive apprehension of God by our intelli- 



THE CANON OF MEDICINE I49 

fT^L l^ ^fic vision But in °« present conditions of earthly life our know- 
ledge must of necessity* make use of concepts and reasoning " (Sauvage- vii , p 8 J. 

§ 162. Occult Phenomena and Powers.— I. Common 
usage applies the term " occult " to such phenomena as psychic 
power healing power, thought-reading, telepathy, clairvoyance, 
crystal-gazing, fortune-telling, discernment of the future, interpreta- 
tion of dreams and visions, medium-ship, character-delineation 
£•&• palmistry) divination, magic, sorcery, hypnotism, obsession, 
willing another who is at a distance to perform some desired 
personal service. Such phenomena are studied in theosophy 
hermetic science, astrology (and medical astrology), spiritualism' 
Christian science, and also figure in new-thought movements and 
many other revivals and elaborations of ancient pagan pursuits « 
(11. 19; xi. 199.) F 

charlatISv ea t S he n fJ?*" Case * ther f, is the suspicion of trickery, deception, fraud, 
charlatanry, the term occultism" is quite properly applied in an entirelv 
different manner,-namely, to the investigation, by the useof reason and loSc 

human SL (l - e The d f n % n0t / elf " e . Vident) CaUS6S ^ efects °P erative i* ordmf ry 
human affairs. The events of one's own daily life, and those of one's fellows are 
all natural sequences of previous behaviour: This is not realized and^vrong 
conclusions are apt to be drawn-such as ascribing good or ill fortune to "fate " 
or an extramundane agency, or to the deliberate ilLill of othen Better kno w 
ledge of such a subject would enable one to avoid misjudging others T and to heTp 
them better, by realising that every soul has his own way to |o and his own manne? 
of proceeding on that way, toward the one final goal of all. manner 

II. Occult phenomena in the common meaning of the term 
are (a) true, (b) false. The latter are achieved by deception, or 
illusion, charlatanry, or may be evidence of self-deception, or of 
disease (hysteria, neurasthenia, mental disorder, insanity) The 
former belong to two categories : (i) Impersonal; that is, explicable 
according to physical laws, though at present only imperfectly 
understood. Such phenomena manifest sometimes in inanimate 
objects, sometimes m organized beings— animal or human (in virtue 
of their possession of a receptive nervous system). (2) Personal. 
(i; Natural; that is, manifested in human "nature" (a) actively 
—in the case of phenomena of the kind referred to in 8 163 • (6) 
passively— m which case the phenomena manifested in one person 
originate m another or in numerous others (e.g. crowd-psychology) 
° r u m J supernatural " beings, (ii) Supernatural agencies : (^so- 
called disembodied spirits ; (b) angelic beings— good and beneficent, 
or bad and malevolent, evil, satanic ; (c) the Supreme Being 

Hi. The word " supernatural " has another application which 
is properly and accurately explained only in Catholic philosophy (see 
Cuthbert,"' p 28, sqq. ; Poulain,"*, chap vi ; Vassall-Phillips" • 
etc). Ordinarily the human being lives a " natural " life, however 
cultured unse fish altruistic, pious, virtuous. He may live a 
supernatural life, by entering a " state of grace," so that the 
human nature is transcended (super), as indicated by Plane V in the 

very oi^niJZ^ ^^^y^^ ^ *** f ° r them at ^ ^ *ere was 



i 5 o THE CANON OF MEDICINE 

Chart. While living such a life, phenomena may become manifest 
(e.g. visions, revelations) which must not be confused with those called 

" occult." ! - 

IV. Emotional states as a basis of occult phenomena. — Strong 
emotional states may impress places and things sufficiently to affect 
other persons in the absence of the original impressor. Obsessions 
and haunted places are accounted for in this way. " A place or 
thing such as a weapon or article of furniture, almost anything in fact 
which has plaved a part in events that aroused very intense emotional 
activity on the part of those who enacted them becomes itself satur- 
ated as it were with the emotions involved. So much so that it can 
influence people of exceptional sympathetic powers and enable them 
to observe the original events more. or less perfectly as if they were 
enacted before them. Thus in some cases the person will see the 
occurrence as if taking place before his eyes." (Pater, 146 ; cf. 

Benson. 157 ) 

V. Occult powers natural to human beings. — Some ot the 
powers enumerated in the previous section are inherent in the human 
organization. They remain latent, or they develop more or less 
unwittingly as life advances, or they are developed by suitable 
training. In a few persons they are naturally so decided as to 
constitute a special talent, which may have been inherited. 

. The possession of psychic powers (clairvoyance, telepathy, thought-reading 
etc ) is sometimes looked on as evidence of special favour, or " spirituality, 
or of superiority (being a " very advanced soul ") to be emulated. Such powers 
are taken as evidence of sainthood in Islam « and among Buddhists 32 . In the 
case of Christian saints, such phenomena are regarded as incidental, and not a 
criterion of sanctity. Not only is there no relation between the presence or absence 
of such powers and the virtue of the individual, they are attainable apart therefrom. 

VI. The basis in the human constitution upon which such 
powers depend is fivefold : 

(i) The vital faculty (161 ; § 134) : vitality . . . . Vegetative Life. 

(2) Instinct (180 ; § 153) Sensitive Life. 

(3) The emotional make-up (159, 164 11 ) : . . 

(The scholastic concupiscible and irascible phenomena) Sensitive .Lite. 

(4) The imagination Sensitive Life. 

(5) The reasoning powers ; deductive logic . . • • Rational Lite. 

§ 163. The following powers are specially pertinent to medicine: 
(i) Ability to read character. — Fundamentally, this_ is the 
instinctive discernment of friend from foe. It exists from infancy, 
and is to be observed among domestic animals. With the develop- 
ment of reason, the consciousness becomes more and more aware of 
the attractions and repulsions produced by another individual, 
whether actually present or only thought of. As life proceeds.the 
contact with relations, friends, acquaintances, and strangers, leads 
to better knowledge of character, though perhaps nothing more than 
a form of " worldly wisdom." The reasoning power may be deliber- 
ately brought to bear, since delineation of character is amenable to 
rule, and can be studied, and taught to others* 

* The Chinese sought to establish a relation between character and physique 
as long ago as 450 u.c. (Wieger, 144). 



THE CANON OF MEDICINE j SI 

As mbusiness, so in medicine, it is a subject worthy of attention. 
Indeed it is always imprudent to neglect it. 

(ii) Telepathy. Thought-reading.— -These depend on the first 
three of the above-named powers, and not on reason. They cannot 
be learned from books, and the experience cannot be taught to 
others. _ The most striking examples of genuine powers of this kind 
are furnished between (a) parent and offspring, when there is intense 
mother love ; (b) persons between whom there is special friendship ; 
(V) husband and wife, when there have been years of unbroken 
mutual understanding. 

Since they are powers inherent in human nature, they may be 
developed gradually by concentration and will-power, exerted— not 
over others, but over oneself. (Cf. P'u. Sung-Ling. 153 ) 

(in) Healing power. — (a) Involuntary. Success or failure in the 
handling of many cases in ordinary practice is usually ascribed to 
the concrete methods employed or the appliances used. Yet it is 
often thought that the personality of the doctor (whether he be 
specialist or not) has at any rate something to do with the efficacy of 
the treatment. 

• a The followin g factors contribute : inspiring confidence, the bodily state being 
influenced through the emotions ; possession of great vitality, which favourably 
influences a debilitated state through the vegetative powers, even apart from actual 
personal contact ; will-power even if used unconsciously has a bracing effect on the 
pat-ient ; psychic power, even when the owner is unaware of it, may directly influence 
1 j OC u me and hormonic ( e -&-) activities beneficially, and the vegetative life in general 
A disharmonious person will actually drain vitality from a weakly person. 
The mother's touch takes away the bodily pain of her little boy. 

(b) Voluntary.— Among the laity there is sometimes a deliberate 
attempt made to develop so-called specific psychic healing powers, 
through healing circles, and the like (theosophy, Christian science^ 
etc.). 

_ The fact that such practice is at the expense of exact anatomical and physio- 
logical knowledge and is exalted above medical training, cannot but arouse condem- 
nation. Medicine herself is not a little responsible for the rising up of " healers " 
m her lack of appreciation of the insistent reality to many patients of the sufferings 
which she cannot explain or find a physical basis for. On the other hand, if the 
psychics " possessed genuine powers, they would not lose them by going through 
the proper doors of the medical curriculum, and their patients would be the gainers. 

(c) Miraculous healing. — By this term is meant supernatural 
intervention apart from human instrumentality. 

_ Of this it might be said that Medicine would not suffer by candidly acknow- 
ledging its occurrence through her leading voices. Not to do so exposes her to 
disrepute m the minds of those who have experienced the cures, or have personally 
met with such cases. Though ignorance in various forms (prejudice, intolerance 
party spirit) is inevitably in her ranks, it should not be chargeable to Medicine 
herself. 

.„ " The sectarian thinks that he has the sea ladled into his private pond " 
(lagore, Fireflies, 209). e 

§ 164. Lists of Terms applicable to Mental Faculties 

and Affections 
Individuals may be described in terms of a series of " notes "— 
the physique, the emotional make-up, the temperament, or disposition, 



i 5 2 THE CANON OF MEDICINE 

the character, and the talents or intellectual capacities. These 
together make up the " individuality." 

The following lists under each " note " do not attempt complete- 
ness, and some of the descriptive words might be placed equally under 
other headings than those given. 

I. Physique.— (i) General.— Robust, spare, wiry; strong or delicate 

("constitution"); good or deficient amwH-'<?»» cla^si- 

(ii) Special.— Classified according to the nine systems of Dr. Abbott s classi 
fication or according to such types as these (Stanton* -)-vege tative thoracic 
glandular muscular, osseous, nervous, etc. Basis: features of the face siz- 
and shape S head, hands, fingers, feet, etc. Throughout, it is necessary also to 
speci y the qualities' of strength and weakness in their degrees (i. si ight or minimal 
2 moderate ; 3, normal, average, mean, or " equable ; 4, well-marked , 5, *ery 

"^T^MOxToNT^MAKB-UP.-Classification according to the five headings 
of the table in § 160. Basis: the character and phase of the breath ; the degree 
of vitality • the dominant imponderable element ; the dominant humour To 
draw up a formula to represent the emotional make-up conveniently for clinical 
wotI the initial letters of the (Latin) names of the emotions may be used,the dominant 
Amotion being expressed by a capital letter. Degrees of intensity are indicated 
bv index Lurls drawn up as in the preceding paragraph. For example, a Timor - 
pison mfght be represented by ^formula g* 1- tr* i> T* ; an Ira "-person might 

be ^^^^l^cRiMiiK of the Several EMoxioNS.-These are arranged 
alphabetically, and not according to order of severity. In some cases the words 
apply also to mental states or attributes sometimes associated with the given 

emOti 7 ^: ty blissful, buoyant, ecstatic, enraptured, enthusiastic, entranced, exalted, 

^^iS^affectionate, amorose, cheerful, contented, eager, excited gay 
inquisitive lively, love of (a) objects (collecting spirit), (6) wealth m various forms , 
(°) q opposrte sex ; pleasure ; sentimentality ; sympathetic. (Some of these convey 

MeaS != te< achJng S^ffictiL, anguish, anxiety, bitterness, ^en^arted, 
chagrin cheerless, dejected, depressed, despondent, discontented displeased, 
^quieted, distressed, fretting, gloom, grief infelicitous, ^^■ 1 ^^S. 

S^^r^^nT^seSei ^olSd^^^S^ ^d^ 

tribUl t^ ^^o^^^^^^s, bellicose, ^ter, boiling bold, 
bristling cantankerous, capricious, captious, caustic, choleric, churlish, contentious, 
contary cross, cynical, daring, desperate, displeased easily ofi ended, ^asperfed, 
exceptions excitable, fierce, fiery, fractious, fuming, furious, hasty, having hatred, 
topeCus indignant, infuriate, irate, irritable, irritated, jealous, passionate .peevish, 
petted, petulant, pugnacious, quarrelsome, querulous rabid ragi ng ^lentless, 
resentful, severe, shrewish, sore, storming, sulky, sullen, suspicious, tart, testy, 
vengeful, vexed, vindictive, violent, virulent wrathful. _ o . , , , hrow . 

Fear : afraid, aghast, alarmed, anxious, apprehensive, astounded brow- 
beaten, cowardly, cowed, coy, craven, daunted, despairing, despondent, £ffident, 
discouraged, dismayed, disquieted, dreading, envious, *f*-^^\^XI' 
fearful fidgetv flinching, flurried, frightened, fussy, gentle, harassed, hesitating, 
hoSedrhlr/or-struck, Irresolute, irritable, jealous, mistrusting, . ^^ous panic- 
stricken penitent, perturbed, pious, pusillanimous, quailing, quaking quavering, 
fepentant P restless, Scared, scrupulous^ shrinking shuddering, sh y : ;kulking sty 
solicitous, startled, suspicious, temperate, terrified, terror-struck, timid, timorous, 
trembling, trepidation, unmannered, weak-hearted, whining, worrying. 

Moods. Moodiness. Disposition. " Moods are the waves rising in your 
heart " They are due to the changes in the breath from hour to hour or day tc .day 
The rate of change varies in different persons. When the change ^comparatively 
frequent, the person may be described as moody, -changeable. Tms character 
may occur more at some periods of life than others in the same perso n ; Thus 
it is more frequent at puberty and during youth. It is possible to rise above the 
cycle of moods, by the exercise of self-restraint. Moods change with surroundings 
(places and people). 



THE CANON OF MEDICINE i 53 

III. Temperamental type, or disposition.— Basis : the humoral formula 
This is expressed outwardly m differences of (a) texture-varying solidity of the 
tissues of the body ; (b) development of the various parts of the body • (c) rate 
of activity of (i) vegetative processes-nutrition, waste, formation of' germinal 
cells, etc (u) expenditure of nervous energy ; (d) tonicity of muscles and nerves 
The words descriptive of temperament often apply also to II. Examples ■ aggres- 
sive, amiable, austere, buoyant, capricious, cheerful, chilling, churlish; complfcent 
conservative courageous, depressed, despondent, discontented, energetic enthusi- 
astic, excitable, fastidious, forbearing, fretful, forward, gushing, harassed impetu- 
ous indolent, intolerant irascible, irritable, jealous, malicious, moody, obstinate 
petulant, querulous, rebellious, reckless, remorseful, ruffled, secretive spiteful 
stubborn, submissive, suspicious, taciturn, tranquil, tyrannical, uncompromising 
unforgiving, verbose, vindictive, zealous. P mg ' 

Many of these terms also apply to the description of II and IV 
It is worth noting that among these types there are many' which are sun- 
posed to be evidence of high human aspirations, and yet strictly belong to the 
• l^er mind. Hence it has been very truly said : " Those sweet affections which 
incline the heart to God . . . come from the sensitive temperament, or bodily dis 
position rather than from the solid piety of reason, and are carnal rather than 
STL (Las^ "•)•-" Things that are apparently of the highest order in know- 
ledge and art and sentiment are not things of the spirit, but things of the sensel 

^ai^orthft^^cSr Aqumas and in the modern rfsearches inTe> 

IV Character.— This is really a collective term, since all the other " notes " 

contribute to it The terms which describe character may be groujed under 

sensuous, intellectual, moral, and aesthetic groups, or under the five subdivisions 

""£ f Ufi * ermmol °gy ( E go, Memory, Mind, Heart, Conscience) Many 

rou afone m ° re ^ com P OIlent ' and therefore do not belong strictly to one 

Ego : Positive: acquisitive, amative, approbative, artful, artless avaricious 
arrogant boastfu. churlish, domineering, gluttonous, grasping, grouching inquteTtivI' 
jealous, lewd licentious, loud, obdurate, obstinate, puinlcious, S quXlsome' 
sociable, superstitious vain, voluptuous, worldly. Negative : abstem ous apathetic' 
hasty indolent, indulgent, miserly, shy, timid, unselfish, weak pathetic, 

pm . ft ,"?. ; Positive : accessible, adaptable, affable, altruistic, ardent, benevolent 
contemplative, emotional, charming, compassionate, facetious, fascinating frivolous 
gay, harmonious, hospitable, lively, peaceable, philanthropic, sincere Ste 
tranquil.— Negative : tepid, meek, lenient. ^ ' ' falm P ie . 

,.„„« Con J dence •' Positive J ascetic, austere, blameless, brave, conscientious 
conservative, courageous, diligent, exacting, fastidious, humble, industrious perl 
severing, scrupulous, sensitive, strong-willed, thorough, truthful well-balanced 
Negative: deceitful, defiant, flippant, impetuous, impulsive, imprudent mafc tons' 
pusillanimous, resentful, slow, treacherous, unforgiving, ungrateful unsociaMe' 
untruthful, vindictive. (The moral sense may be absent) unsociable, 

Mind Agnostic ambitious, brusque, censorious, cunning, enterprising 
foreseeing, intellectual, loquacious, methodical, opinionated, orderly piauslblf' 

?nner 1 t; C A ; o Pre]UdlCed ' ^^ "^^ S&titiC&1 - S ^P tiC ' seri °^, StUtef SuM e' 
superstitious, uncompromising. ' auuulc ' 

It should be noted that character is ^) native and unalterable 
(whatever some educationists say) ; (b) capable of being fashioned by 
the will of the person himself or by that of the persons amongst 
whom he lives. To have a " strong character " is considered the 
highest ideal by many ; (b) is therefore much advocated. But this 
idea is not necessarily true. Animals have character in that different 
kinds of ego are as it were personified in them. (cf. Paracelsus^, p. 209) 

Character is necessarily intimately related to physique 
emotional type and temperamental type. Hence character de- 
lineation is possible from a close study of those aspects. 

The skeletal system (bones, joints, ligaments, muscles, etc.) is ' 
the expression of the character of the cerebral nervous system. 
ine viscera are the expression of the character of the vegetative 



I54 THE CANON OF MEDICINE 

system. Hence it happens that the usual autopsy discusses the 

least important part of the " case." (See §127.) 

Interests Ex. : personal interests : the preservation of one's life and 
health and general welfLe ; interests of the family ; of the social circle, etc. 
Tr,+prp=d-c; manifested in the usa of the various talents. , . , ,j_ 

htU V t™ -These are best classified according to the subject-matter 
to which the mind is directed ; though they may be classified according to the 

faCU %LTaS d ' constructiveness; architecture, etc. ; technology 

Scientific : all branches of learning ; mathematics, sciences, logic, analytical 

tilents ■ calculating powers. Domestic science. Administration. 

^ intelUauat: til branches of knowledge Philosophy,, history, sciences 

JEsthetic: arts and crafts, music, sculpture designing, painting, poetry, 

literary art, dramatic art ; wit ; women's crafts of all kinds ; poise. 
Imaginative : originality ; inventiveness. 

Moral : perseverance, concentratmg-power, law. no A~„ n <nr ■ 

Other talents: language; intuitive perception; foresight; pedagogy, 

rhetoric; vocal. , , „ A 

Social : domestic interests ; love of children of home. , 

Political. Military. Sport (athletics, acrobatic art, adventuresomeness) . 

Commercial life. Agriculture, Husbandry. Ttmieht 

Much overlapping is necessarily present m preparing such a list It mignt 

be extended to mcPudf all the subjects taught in universities, and schools of all 

kinds, for persons of all ages. 

S 165 Interactions between the various aspects of the Soul. 

I. Intellect.— Acts on vegetative life via emotions. (Effect of emotions on 
bodily functions : § § 139,160) 

IS (tffegtauZlife : physical desires, sense-impressions, especially in dream 

(M s£iHv,% ^psShical desires, either in oneself or from others. The 

imagination influences it in hypnosis. 
(c) The will :■ compelling attention or forcibly diverting attention. 
8 Other wills : ditto, includes angelic ^intelligences as well as : ^man 

II. Reason.— Acts on vegetative life vi& the emotions, with their desires 

aQd fe is r acted on by sensitive life. Emotions strongly affect the reason in people 
of certain ^Positions life _effecting exterior actions. 

Acts on fens^ve life. Through sensuous cognition it acts °n the emotions 
feeds or starves or fails to starve the sensitive appetite, and so acts m the same 

^J^Z^^^^^^^^^ aid of bodily mechanism it 

l6adS A^n^S^ r^^^P-duc-es acts of Judgment, or worship, 

or contemplation. . ,, 

Acts on the intellect : " concentration. 

Acts on the memory : " recollection," watchfulness. ron rKved 

Acts on itself : brings perseverance in the performance of a design conceived 

and elaborated by the intellect. 

^'™ l&^aTSnen this propounds to the will what is the greatest good ; 

^Trr^ir^fol in nullifying will to good, and ^sing 
will to evil So also, fear of another person, fear of an idea, fear of a thing ^ssions 
hinder the judgment, and so affect the will. Emotions can be sublimated by mter- 

^W vfTpMile : this acts directly on the will. If the objects * .both 
appetite and will coincide, the will is strengthened , otherwise it is ^^ 
"The passions modify the organic conditions and this influences al ? ^gmtive 
faculties, and their intensity may prevent the mind from applymg itself to the 
higher operations of the intellect and will (" 9, 10, 77 I *•. P- 6 5<>)- 

Vegetative life : the corporeal state affects the will „„.,..,.„ 

Environment : circumstances of life, personal atmosphere of neighbours, 



THE CANON OF MEDICINE i 55 

etc. ; presence of persons of strong will, all interfere with or modify the actions of 
the (patient s) will. J 

Diseases of the Will.— Inconstancy, irresolution (lack of energy), impulsiveness 
(excess of energy ; excitability), and " mortal sin " (domain of moral philosophy). 

IV. Practical Application.— The fact that feelings, im- 
aginations and thoughts influence the character is of the greatest 
practical importance, but by using the will-power to control them all, 
one becomes also master of one's life and " fate." Each emotional 
" note " has its own effect on body and mind, and can be over- 
ruled by the will. The influence of the imaginations is implied in 
the phrases ' ' looking on the bright (or dark) side of things . ' ' Cheer- 
ful, gloomy, constructive, destructive, upright, deceitful thoughts all 
affect the sum-total of the conduct, the attitude of the mind towards 
others, and can all be over-ruled by the will. 

" If the endowment is great in one direction, it is at the expense 
of some corresponding defect in another direction, as when tender- 
hearted men are lacking in judicial faculty, while men in whom the 
judicial faculty is prominent tend to be tyrannical" (Chu Hsi, 1 " p. 59). 
The study of all such interactions as are suggested by the lists 
of synonyms above given affords a better idea of what constitutes 
ideal " balance " in regard to the various components of the human 
being. A more graphic and tangible idea is at the same time 
obtainable in this way of much of the subject-matter of ethical and 
moral philosophy. To assign a distinct place for it in the domain of 
Medicine is not to disown the precedence of religion. 



THESIS I. DISORDERS OF HEALTH 

i. Definition of the Terms *. Cause, Disease, Symptom 




191. Cause. — The word 
" Cause/' in medical works, 
refers to that which initiates a 
given state of the human body, 
or maintains a fixity of such a 
state. 



§ 1 66. It is to be noted, says Costasus, that the term cause does not refer to 
" efficient " cause, for disease, not being a definite entity, does not require an efficient 
cause. In other words, disease is not in-formed matter. — This applies equally 
in modern thought. If the changes of disease are modified biochemical reactions, 
they cannot be considered in terms of matter and form. But formal causes, and 
substantial causes, as well as the differences between qualities and dispositions, 
tendencies, passive and active states, and fixed morbid conditions, are all better 
understood under the precise thought of modern scholastic philosophy. — A cause 
may be understood as anything which effects, or assists, or maintains, or imparts a 
(morbid) function, whether actively or passively — morbid, because this part of 
the Canon is concerned with disease. 

Human body. Not an animal body. The teaching to be presented does not 
necessarily apply to veterinary medicine. 

Fixity of state. — Note that some states are labile, and others are stable or fixed. 
Labile states are more or less easily curable, but fixed states are very difficult to 
resolve or cure. 

State. — We must distinguish carefully between cause, disposition, state, habit, 
symptoms. 

192. Disease. — This is an abnormal unnatural state of the 
human body, in virtue of which injurious effects result. This 
injurious effect is the beginning of the disease. Such an ab- 
normal state is either (a) an intemperament, or (b) an abnormal 
composition (see 205 5 231.). 

§ 167. It may be noted that on this view the state is primary, 
and the disease secondary. To the modern view, the disease comes 
first, and the state is its result. The state is " the reaction to the 
causal noxious agent." Such a state is (i) detrimental to the body, 
(a) by an " aggressive " action upon the tissues by the agent, (b) 

156 



THE CANON OF MEDICINE 157 

as an unfortunate by-effect, producing degenerations of various 
kinds and degrees — sometimes mechanically (pressure on parts, 
interference with vascular supply) — sometimes incidentally, in the 
form of late toxic actions of the microbic poisons, (ii) beneficial to 
the body — though indirectly, since it is certainly damaged in the 
process — as tending to destroy the invading organisms or at least 
neutralizing the poisonous products. 

In Avicenna's view, however, both agent and state are equally 
important. One cannot speak of a " reaction," any more than one 
would say (for instance) that sodium carbonate is a reaction to 
hydrochloric acid. Unless both substances are there, there is no 
reaction. So, without an abnormal state, there is no malady. 

Note also that " poisoning " (" intoxication ") is not a disease. 

§ 168. The following classification of words often used indifferently for 
" disease,' as if they were really synonymous, will help to a more precise usage. 
A - — Terms bearing primarily a general sense. 

Ill-health : not used specifically ; there may or may not be a diagnosable 
" disease." 

Illness : the state of being ill ; sickness. Vaguely used for anything 
from slight disability to a fatal condition. More definite in meaning 
than " ill-health." & 

Malady : (lit. ill condition ; male habitus). A synonym for " an illness," 
appearing in polite literature for conditions not necessarily organic 
or for conditions which have not been diagnosed, and yet may prove 

IcLlcLJ.. 

Ailment. This may be some definite morbid condition, or simply implv 
discomfort (possibly short of actual pain). Literally, is synonymous 
with " a sickness," " an illness." 

Disorders, in general, (cf. 198.) This term is used still more specifi- 
cally, as a rule. See under B. 

Disease (Morbus. Marad) in general. This word is technical, whereas the 
other words have a more popular application. 

B - — Terms bearing a special sense, whether used in that manner or not. 
(i.) Any condition in which an organic lesion — some macro- 
scopic change in the body — is present, is - " disease " 
This word implies a more or less serious disturbance, and 
even suggests the risk of death. The lesions present 
often determine the distinctive name of each separate 
disease. Where the etiology is still unknown, the 

disease may be provisionally named ... "sickness" 

(ii.) Conditions in which there is not necessarily any organic 
lesion, or where such a lesion has not been detected. 
These conditions do not receive distinctive names ; are 
not necessarily serious ; are probably not fatal. The 
name of each condition originally bore a distinct 
meaning : 

(a) arising out of the temperament - " distemper "* 

(b) arising out of the disposition or state. Now 

means simply " not fit " ; or, vaguely, " ill- 

health." ----... "indisposition." 

(c) implies involvement of bodily functions. May be 

sub-classified according to the "system" in- 
volved. . Or, vaguely, means simply " some- 
thing is out of order." ---.. "disorder" 
(a) implies involvement of the nerves, or nervous 
system. (I.e., almost equivalent to " functional " 
as opposed to " organic " (Lat. passio). Implies 
a certain amount of pain - - - " ,iff fi -tioK " 

* Now only applied to a specific disease in veterinary surgery. 



i5« 



THE CANON OF MEDICINE 

(e) A condition in which pain is the chief, feature, 
whether general, or in some special region ; but 
the pain is presumably not very severe. Sub- 
classification according to the region or organ 



" complaint." 



193. Symptom. This is a phenomenon consequent upon 
this non-natural state of the body. Some symptoms are entirely 
abnormal phenomena, like the pain of colic. Others are (ex- 
aggerations) of a natural phenomenon, like the intense flush on 
the cheeks seen in peri-pneumonia. 

§ 169 A lengthy discussion about what is to be regarded as a symptom is 
here given by Costasus. He shows that the word " symptom " is derived from the 
Greek to indicate something which occurs simultaneously with the disease producing 
it He also discusses the exact meanings of the terms : weakness, impaired func- 
tion loss of function, abolition of function, " affections," preternatural excretions 
and retentions (cf. " retained " placenta). The question is also raised as to whether 
a given symptom is directly due to the disease, or is indirect, or is collateral, or is m 
no real relation to the disease. 

Avicenna's brief statement really covers all these points. As regards our 
modern ways of thinking, one gathers together all the phenomena which are ever 
found to occur in a case of a given disease, and we simply arrange them as far as 
possible into the immediate effects, the remote effects, and those phenomena whose 
nature is not absolutely certain— thev may be caused by the disease ; they may be 
sequels ; or they may be concurrent because some other morbid condition is, or 
happens to be, simultaneously present. 

194. A short table of examples. 



Example of a cause. 

Decay ; putrescence. 

Fulness of lacrymal sacs from 

developmental error. 
Acrid " flux." 



Example of its 
corresponding malady. 



Fever. 

Obstruction of uvea. 

" Ulcer " in lung. 



Example of the 
corresponding symptom 



Thirst, headache. 
Loss of vision. 

Flushed cheeks ; curved 
nails. 



195. id) The difference between " symptoms " and " signs." 
We speak of a symptom in regard to its own intrinsic character, 
or in relation to that to which -it belongs. A " sign " is that 
which guides the physician to a knowledge of the real essential 
nature of the disease. 

It is asked : Are symptoms to disease as shadow is to object ? The answer is, 
that the two are associated but are not inseparable. In other words, the symptom 
is a (scholastic symbolism, of §56, sqq.) and not m.f. The term " " symptom 
refers to many phenomena, some of which are really the direct consequence of the 
disease, while others are only indirectly its result. This question would never 
arise were it not for the custom of supposing " diseases " are entities of some kind. 

(b) One disorder may originate a second. Thus colic pro- 
duces syncope, or paralysis, or spasms and convulsions. 

Costseus says : To the patient, " colic " is " pain." The distension is the 
cause of the pain. The pain interferes with or even arrests the vitality ot the part, 



THE CANON OF MEDICINE 159 

and in that sense produces the syncope. Pain is : the contact of disordered 
disorganised function upon the consciousness. It is a form of " touch." The 
consciousness " touches " the impaired function. " Paralysis " is " loss of the 
faculties of movement and sensation." "Convulsions" = "depravity" of the 
faculties of movement and sensation. 

There is, therefore, a certain literal truth in the general statement. 

(c) A symptom may be the cause of a disorder. Thus, violent 
pain causes the suffering of colic, and syncope is the effect of the 
pain. The violent pain of an inflammatory mass is due to the 
descent of the matters to that spot. 

Costseus adds : Pain interferes with the " breath," and may even arrest it. 
In consequence, a " refrigeration of the heart " takes place. That is, the tempera- 
ment of the heart becomes below normal in regard to " cold." But this is a disease. 
This change of temperament accounts for the syncope. 

Descent of matter (inflamm. exudate) as a cause of pain. — The acridity and 
similar qualities of the exudate do actually irritate the nerve-endings, and therefore 
produce pain in addition to that due to tension. 

(d) A symptom may be at the. same time a malady. Thus 
headache is an effect of fever, but may also last so long as to 
amount to a disease." 

§ 170. Costasus adds : Pain such as headache may simply 
be a symptom, that is, evidence of an " intemperamental state," or 
" solution of continuity." But, to the patient, it is the thing ; it is 
the malady. — Little does it concern the patient that there is an 
underlying cause to be treated if the practitioner proves unable to 
relieve his pain. 

Further, persistent pain impairs vitality ; in this sense a pain is 
a disease. 

§ 171. Symptoms are still confused with diseases in our text- 
books. Thus, "jaundice " appears amongst the diseases, instead of 
being placed separately along with a number of other characteristic 
symptoms, such as ascites, which is not taken as a specific disease 
even by the lay. Originally, symptoms were explained in terms of 
changes of quality and the like. This theoretical explanation was 
abandoned owing to a degradation of (metaphysical) knowledge. 
The symptoms then became " diseases." The diseases were then 
investigated, and found to be more numerous than the symptoms 
(which was already understood). Subdivisions were then made, and 
particular diseases specified and defined, and the multiplicity of 
causation emphasized. The exact succession of processes revealed 
by the microscope and biochemistry was elucidated. These succes- 
sive procedures are ihe evidence of " advance " and " progress." All 
the while the fact is overlooked that the same processes occur in every 
'' disease," and that when the whole subject, treated from pathology, 
is reduced to its least common multiple that range reveals itself as 
much the same as that' of ancient lore. Cf. also § 173. 

(<?) One and the same thing may be at once " disease" 
" symptom " and " cause." Considered in relation to the present, 



160 THE CANON OF MEDICINE 

it is " disease" -/considered in relation to the past, it is " cause" ; 
considered in relation to the future, it is 'symptom.' —Ex- 
amples : the fever of consumption is the sign of ulceration of the 
lung. Considered in itself, it is the disease. Considered in its 
effect, it is the " cause " of gastric weakness. Again, the head- 
ache which fever gives rise to (in those cases where fever causes 
headache) (esp. "meningeal disease) may remain behind (after 
the subsidence of the fever) and be itself the " disease." To 
particularize, the malady itself sets up inflammation of the 
meninges, and this sets up headache. 

2. The States of the Human Body. The Types of 

Disease* 
196, There are three states of the human body, according 

to Galen : — . 

(i) Health— -a state in virtue of which the human body 
presents that particular temperament and configuration whereby 
all its functions shall proceed unembarrassed. 

(ii) Disease — a state which is exactly contrary to (1). 

(iii) A third state which is neither health nor disease. 
There are three variants of this :— (a) the health is not perfect 
and yet there is no actual illness. Ex. : the state in old persons, 
and in juveniles, and in those convalescent from illness. _ (b) 
Both states occur simultaneously in the same member : either 
in two quite different respects (as when the temperament 
of a person is normal, but there is compositional abnormality ; 
or in two respects which are related to one another (as when a ' 
person is healthy in form, but there is error in size or position of 
a member ; he may be healthy in regard to two passive qualities, 
but not in regard to two active ones), (c) Both states occur in 
one person, but at different times of the year (as when a person 
is well in winter but ill in spring). 

197. Some disorders are simple, and others compound. 
The simple disorders are where there is (i) one single kind 

of intemperament, (2) an isolated abnormality of configuration. 

The compound (composite, compositional) disorders are 
where there are two or more kinds together, which together 
appear as one single malady. 

198. The simple disorders comprise three groups : — 

1. 'Disorders of Temperament. — In this case the members 
affected are formed of similar parts, but the temperament is 

* Costajus believes that Chapter I of the original should come in here, the 
present chapter being the real opening of this Thesis. 



T 



THE CANON OF MEDICINE 



161 



depraved. The term is not used unless the disorder is primarily 
in these essential parts, and then applies even if composite 
members are affected secondarily [i.e., temperamental disorders 
are distinguished from compositional (205)]. 

Disorders of temperament may actually occur in any 
compound members one may think of, provided these are 
formed of homologous tissues. 

There are sixteen kinds of disorders of temperament, as has 
been already stated. (41). 

2. _ Disorders of Configuration. The members affected are the 
locomotive organs (the instruments whereby actions and functions 
are performed). These organs are formed of similar parts. 

3. Solution of Continuity and Dislocation. The members 
affected have similar parts. It occurs in organs which are 
instruments. The disorder is one in which the function of being 
an instrument is interfered with. Such a solution of continuity 
occurs at a joint ; here we see that the separate members which 
go to make up the joints are not affected. The same thing 
applies in the case of nerves, bones, veins. 

Any malady which depends on any of these three groups is 
named accordingly. 

3. Disorders of Configuration. 

199. These are comprised in four main groups : (i) 

Errors of development (malformations), (ii) Errors in bulk, 
(iii) Errors in number, (iv) Displacements. 

(i) Errors of Development. 



Group. 



1. Errors in form. 
Here the form is 
changed from its 
natural grace, to an 
extent which impairs 
its utility. 



2. Errors in passages. 



Subvarieties. 



Deviation from a natural 
straightness. 



Straightness of a naturally 

curved line. 
Squareness where there 

should be roundness. 
Rotundity where there 

should be squareness. 



Examples. 



Too wide. 



Too narrow. 



Occlusion. 



Head broad and round, with 
ossified sutures to an ex- 
tent hindering mental 
power. 

Curved shinbones ; genu 
valgum ; clubfoot. 

Pupils congenitally elongate 
or slit-like or small. 

Great rotundity of abdo- 
men. 



Wide pupils ; varices ; 
aneurysms ; the dilated 
blood-vessels in pannus. 

Small pupils ; narrowed 
eyes ; stricture of trachea 
or bronchi ; stricture of 
oesophagus. 

Of venous orifices, e.g., in 
liver. Atresia (Tr.). 



I 62 



THE CANON OF MEDICINE 



Group. 



3. Errors in cavities 
or sacs. 



4. Errors of surfaces. 



Subvarieties. 



Too large (distended). 
Too small (contracted) . 



Obstructed and overfull. 
Emptied. 



The normal roughness re- 
placed by smoothness. 

The normal smoothness be- 
comes rough. 



Examples. 



Scrotum. 

Contracted stomach ; con- 
tracted cerebral ven- 
tricles in epilepsy. 

Obstruction in cerebral ven- 
tricles in apoplexy. 

Cardiac cavities emptied of 
blood by reason of ex- 
cessive joy or extreme 
pain. 



At the orifice of the stomach; 
also in lienteric diarrhoea. 
Trachea ; fauces (hoarse- 
ness) . 



(ii) Errors in bulk, {a) Increase : as in elephantiasis, 
unduly large penis (priapism) ; macroglossia. The disease 
which befel Nicomachus, whose body became so huge that he 
could not be moved, (b) Decrease : shortness of tongue so that 
it cannot reach the other parts of the mouth _ (tongue-tie). 
Atrophied and wasted members ; general " decline."* 

(iii) Errors in number. (a) Increase : (a) in normal 
or g an s_additional teeth ; supernumerary fingers ; (0) en- 
tirely abnormal — warts, calculus, enlarged glands, (b) Decrease : 
(a) in normal organs — congenital absence of a finger ; (0) 
accidental — loss of a finger through amputation (accidental or 
surgical). 

(iv) Displacements, (a) Displacement from the proper 
anatomical position. (a) Replaceable : e.g.^ hernia of the 
intestine ; tremor (which occurs through a quite unnatural to 
and fro involuntary movement). if) Not replaceable : e.g., 
fixation of a joint in a new position, as in gout where joints are 
hardened (ankylosed). (b) Displacement from the normal 
position in regard to neighbouring anatomical structures. 
This results in their being too near together or too far from one 
another. In such a case one part cannot move towards another 
as it should ; for instance, adjoining fingers cannot touch one 

* Decline. — Dhebul. — The term refers to a condition in which the body seems 
to wither or fade away without obvious reason, or in spite of taking food. The term 
refers primarily to the causeless losing of flesh by horses, whereby they come to be 
in an iU-conditioned state. The same word would apply to the wilting of cut 
flowers or the withering of plants from lack of water, or from reduction of their 
vitality to such a point that they will not imbibe water any more ; that is, they 
cannot be " re-vived." Such a condition in man is noted by the laity, but is only 
referred to in medicine when its pathological basis is visualised ; as, for instance, 
in wasting from tabes mesenterica, or tabes dorsalis. 



THE CANON OF MEDICINE 163 

another. Or, one part cannot be moved away from another, 
either at all, or only with very great difficulty. For instance, in 
the case of joints flabby because of paralysis, or in the case of the 
eyelids. There may be a difficulty in opening the hands or in 
opening or raising the eyelids. 

§ 172. Museum- classification of errors of development. 
(Abbott, 105 p. xv.) 

1. Foetal structures normally not persistent. 

2. Incomplete development. 

3. Reduction in size (hypoplasia). 

4. Reduction in number (subdactylism, etc.). 

5. Persistent foetal structures. 

6. Excess of size. 

7. Excess in number. 

8. Malposition ; aberrant structures. 

9. Anomalies due to foetal disease. 

4. Solution of Continuity. 

200. The following members may undergo solution of 
continuity. 

1. The skin (and the flesh beneath it) : as excoriation, 
scarification, wounds. If pus is not formed or discharged, it is 
called a wound ; if a discharge of pus is present, it is called an 
" ulcer." The presence of pus is due {a) to effete matters 
(" superfluities ") being discharged at that spot ; for the reason 
that it is weak, (b) The tissue is not able to digest all the 
nutriment which is brought to it, the excess being changed into 
pus. 

The terms " wound/' " ulcer " may also be applied to 
solution of continuity in places other than skin and flesh. 

2. Bone. A fracture into two parts, large or small ; or 
longitudinally in the form of a fissure. 

3. Cartilage. The fracture may be in any of these three 
ways. 

4. Nerve. Transverse section from incised wounds ; 
longitudinal, and over a short distance, as " scission." Longi- 
tudinal and also extensive — in a contusion. 

5. Muscle. If near the ends, or in the tendon : attrition. 
If transverse : severance, or incision. If longitudinal, but small 
in extent, with the formation of a deep hollow, it is called 
cavitation. If multiple, with the appearance of several swellings 
and hollowings, it is attrition with contusion. If the solution of 
continuity is in the belly of the muscles, it is called attrition or 
incision, or contusion, whatever be the direction of the injury. 



i6 4 THE CANON OF MEDICINE 

6. Arteries and Veins. When these undergo solution of 
continuity, they are " opened." If the injury is transverse, it is 
an incision ; if longitudinal, it is called fission. They may be 
punctured (perforation). There may be a partial solution of 
continuity, whereby the blood escapes into the surrounding 
tissue-spaces, until their pressure arrests its further progress ; 
this is called an aneurism. 

7. Membranes (including the diaphragm) : disruption. 
Note that not every member can undergo solution of 

continuity with impunity. For instance, in the case of the 
heart, death ensues. . 

201. If one of two parts of a composite member be 
separated° from the other, such that there is no actual injury to 
either, it is called a dislocation. A nerve may be twisted out of 
place, and this is also called a dislocation. It is also called a 

contorsion. 

202. When a solution of continuity occurs where there 
are foramina, it may widen them. When it occurs in a place 
where there are no foramina, such may come into existence. 

203. Any solution of continuity, whether it be in the form 
of an ulcer or the like, will heal quickly if the temperament of the 
member be good. But if the temperament be not good, healing 
may be delayed for a long time. Healing is specially delayed in 
persons with dropsy, or cachexia, or suffering from lepra. 

204. If wounds are tightly bandaged, they may end in a 
very deep ulcer. Ulcers appearing in summer may last on into 
winter, and exhaust the strength. 

Resolution of continuity is referred to in detail later. 

5. Composite Diseases. 

205. Definition. — By the term " composite diseases " we 
mean — no t that several diseases are conjoined — but that a 
number of morbid states concur, and out of them there emerges 
one single disease. This is exemplified by cutaneous swellings 
of inflammatory nature (including boils, pustules). Boils are 
small inflammatory masses, and ordinary inflammatory masses 

are large boils. 

The following kinds of morbid state go together to make 
up an inflammatory mass* : (1) a disorder of temperament, this 
being associated with matter ; (2) a perversion of form ; (3) 
unhealthy configuration — one never meets with an inflammatory 
deposit without there being disfigurement, change of size, and 

* Hence the popular name for a local inflammatory condition—" gathering." 



THE CANON OF MEDICINE 165 

there is often displacement as well ; (4) loss of continuity. 
This is the necessary accompaniment of the discharge of super- 
fluities into the tissue-spaces, penetrating as they, do into them all, 
and separating one from the other in order to make space for 
themselves. 

206. Site. — Swellings occur in soft members, and some- 
times also in bone, in which case the cavities in the bone widen 
and the exudate accumulates in them. 

It is not surprising that a tissue which can accommodate 
nutrients should also accommodate waste materials if these 
should by chance penetrate into it, or should form in it. 

207. Causation. — (a) The primary cause may not be 
evident, the corporeal change showing that material has been 
removed from one tissue to another (at a lower level). This is 
called a " catarrh." (F) The material cause from which 
boils and other inflammatory swellings arise may be immersed 
within other humours, without being deprived of its own harm- 
ful qualities. 

Good humours may be discharged either by natural 
processes (as, for instance, in the case of women at the times of 
parturition and lactation), or by unnatural processes (as when 
good blood is^ lost through a wound). The bad humours, 
however, remain and continue to be harmful ; Nature then 
expels them. If the discharge is by the skin, pustules form. 

208. Classification of Swellings. — Swellings may be classi- 
fied according to the different kinds of matter of which they 
are made up ; namely according to the six kinds of material 
cause — the four humours, wateriness,gas. 

There are both hot and cold inflammatory swellings. But 
the fact of their being hot does not say they are derived from 
bilious humour or blood. Any material intrinsically of hot 
nature, or any material which has become hot because of putre- 
faction, can give rise to a hot inflammatory mass. 

Swelling =waram=apostema=tumour (used in a general sense) ; any " lump " 
or excrescence or protuberance. Intumescence, tumefaction, new-growth, nodosities 
— these, are special kinds of swelling. In most passages an inflammatory swelling or 
mass is meant ; waram or apostema is translated accordingly. It may be noted 
that an apostema is more likely to be coloured, and to feel warm to the touch, 
whereas a swelling which can be called a tumefaction is colourless and does not fee' 
warm; that is, it is a " cold " swelling. (211). 

209. While it is possible to subdivide these swellings 
according to the humours concerned, it is better to use special 
names in special cases. Thus, a mass derived purely from the 
blood is called " phlegmon " ; one derived solely from bilious 



1 66 THE CANON OF MEDICINE 

humour is called "erysipelas." When the origin is compound, 
or dual, a double name is allotted. Thus, phlegmon erysipela- 
todes, if phlegmon is the chief feature ; erysipelas phlegmonodes, 
if the erysipelas is the chief feature. When a collection of actual 
fluid has gathered, it is named an " abscess." This may occur 
in lymph-nodes (axilla ; behind the ears ; in the groins) which 
are then nothing but " corrupt " matter ; and this is called a • 

"bubo." , , 

210. Hot Swellings.— The following are the phases of 

the hot swellings : 

i. The onset. The humour makes its way to the surface, 
and increases in size, until the cavity is so distended as to be 
evident, ii. The rise : the size and tension increase, hi. The 
acme : the height of the malady, and stationary period, iv. The 
decline : . (a) stage of softening from digestion of the contents 
and resolution or (b) maturation into pus* ; or (c) a conversion 
into a hard or indurated mass. 

211. Cold Swellings (lit. " swellings which are not hot "): 

1. Composed of atrabilious humour : 

i. induration (generally autumnal), 
ii. cancerf (generally autumnal), 
iii. glandular : scrofulous, other nodules and nodosities. 

2. Composed of serous humour : 

i. lax. 
ii. soft glands ; and winter swellings. 

3. Composed of watery fluid : e.g., dropsy, hydrocephalus ; 

hydrocele, and the like. 

4. Composed of gases : tumefaction ; puffiness ; distension. 

Puffiness. This stands for tahabbuj (Rome edition), or tahayyuj (Bulaq) ; 
cachexia (Venice edition) = tumefaction. The Latin glossary explains that it is 
meant specially as that which results from liver disorder ; when it appears in the 
limbs it has a different origin. The puffiness of the eyes from lack of sleep or from 
too much sleep is also different. 

212. The difference between the glandular form _ and the 
other two kinds of atrabilious swellings. The former is either 
quite loose within the tissues among which it lies, and is therefore 
easily moved to and fro by the finger ; or there is adhesion, 
simply to the skin (as in strumous swellings). The other two 
kinds of swelling are intermingled with, and interfused with, 
the substance of the tissues among which they lie. 

* Note that pus is only one kind of " matter." _ . 

f Cancer appears in the Canon as a disease associated with change in. the 
atrabilious humour. Therefore one condition for the production of this disease 
is the entry of S into the metabolic cycle in a pathological manner (cf. § 147)- 



THE CANON OF MEDICINE 167 

213. The difference between cancerous swelling and indur- 
ation. The latter is a slumbering silent mass which destroys 
the sensation (so that the part is numb), and is painless, and sta- 
tionary. It may produce weakness of the part. A cancerous 
swelling progressively increases in size, is destructive, and 
spreads roots which insinuate themselves amongst the tissue- 
elements, It does not necessarily destroy sensation unless it 
has existed for a long time, and then it kills the tissues and 
destroys the sensation in the part. It would seem that indura- 
tions and cancerous swellings differ less as to substance than in 
the inseparable accidental qualities.* 

214. The hard swellings arising from atrabilious humours 
are usually hard from the outset. They are often autumnal. 
They often become " indurations," especially if there be san- 
guineous humour present. — The same sort of change may take 
place in the swellings arising out of serous humour. 

215. Swellings arising out of serous humour. These are 
of two varieties. They are either diffuse or circumscribed 
(nodular). The difference lies in the fact that the latter form is 
discrete among the surrounding tissues, whereas the other form 
is intermingled with them, and is therefore not discrete, but 
diffuse. Swellings formed of serous humour often arise in 
winter (the rainy season, or time of stormy weather). (Even) if 
they are " hot," they are white in colour. 

216. The difference between soft glands and " ganglia." 
The latter are more adherent to the surrounding tissues ; they 
feel nodular to the touch ; they always slip back to the original 
position after manipulation ; but they may be dispersed by cer- 
tain strong medicaments, without compression, and then dis- 
appear permanently. They are often produced by toil. The 
application of a very heavy weight such as lead may disperse 
them. 

217. Swellings arising out of serous humour vary in 
consistence according to the density of the contained fluid. 
They may be soft, thin, lax, or hard, or resemble the atrabilious 
type of swelling, or resemble the gaseous form. Tenuous serous 
humour flows down along the course of the nerve-fibres, and 
so reaches the muscles beneath the epiglottis and larynx. 

218. Watery swellings. Examples : dropsy, hydrocele, 
hydrocephalus, and such-like. [Cysts.] 

219. Gaseous swellings. These are of two different kinds: 
tumefaction ; inflation. These differ both in essence and in 

* Hence some cases of " Induration " may have been what is now called 
" scirrhus." 



Z 68 THE CANON OF MEDICINE 

mode of commixture. In tumefaction, the gas is intimately 
mixed with the substance of the tissue. In inflation it is aggre- 
gated 'tense, tumescent, and discrete from the substance of the 
tissue. The former feels soft ; the latter feels more or less 

220. Papular swellings. These show the same subdivi- 
sions as inflammatory swellings in general. They are formed of 
(i) blood or sanguineous humour (true pustules) ; (2) purely ot 
bilious humour : miliaria, sudamina, certain forms of eczema ; 
(3) both serous and atrabilious humour (morbilh, myrmecia, 
clavus, scabies, warts, and the like) ; (4) watery fluid (bullae, 
vesicles) ; (5) gaseous material (emphysema). _ 

The points of distinction which apply in regard to the kinds 
of pustules will be adequately dealt with in the fourth Book, 
should Allah be willing for its accomplishment. 

6. Disfigurements 

221. There are some states which are not " disease," but 
are classed as such. These are conditions in which the beauty 
of the form of the body is impaired, either in respect of hairiness, 
colour, odour, or form. 

1 . Affections of the hair. Alopecia ; stumpmess ; scanti- 
ness ; shortness ; scission ; fineness ; coarseness ; curliness ; 
lightness ; colour-changes, such as greyness. 

2. Affections in which there is an abnormal colour of the body. 
i. Due to an intemperament : 

(a) material : jaundice. 
\b) non-material : 

(1) very cold intemperament : chalkiness ; 

(2) very hot intemperament : citron-yellowness, 
ii. Due to extraneous agents : scorching sun, extreme 

cold ; much exposure to wind ; 

iii. The presence of unnatural colours in the skin : [a) 
brought into the skin (vitiligo nigra), (b) arising in it (freckles, 

iv. Relics after the healing of scars : pock-marks • old 

ulcers. , r 

1 Affections associated with bad odours ; Ex. : rcetor or 

the mouth, or objectionable odour of the whole or of portions 

of the body. . . 

■ 4. Disfigurements. Ex. : Great emaciation ; excessive 
bulk ; undue thinness and fatness. (Malformations.) 

" Excessive corpulence and excessive leanness are especially worthy of con- 
demnation " (Charaka-Samhita 155 : i. 233). 



THE CANON OF MEDICINE 169 

7." The Stages of Disease 

222. Many diseases show four stages — onset, increment 
acme, and decline. These are distinct from the phases of health' 

In speaking of " time of onset," and " increment," we do 
not wish to convey the idea that there are two extremes during 
which a. state of disease is indiscernible. Each stage can be 
detected by the senses, and each has its own characteristic signs. 

1. The " onset " is that period of time during which the 
disease is becoming manifested, and its characters are commenc- 
ing to develop. There is no evident change in degree. 

" ****?* " djpase belongs here ; " occulta " as compared with the other three 
stages, which are declared," " visibilia." 

c M1 2 - The , " i^ement " is the period during which the degree 
or illness is hourly becoming more and more decided. 

3- The " acme " is that period during which all the 
characters of the illness have become manifest, and remain so. 
.4- The "decline" (defervescence ; terminal stage) shows 
abating of the signs of illness ; and the further this period 
advances, the more nearly is there freedom from the symptoms 
of the diseases. r 

These stages may be applied both to the illness as a whole 
and m regard to each of its component attacks or paroxysms' 
In regard to the whole course of the disease, they are called 
" general " ; in regard to each of the attacks which occur 
m its course, they will be called " special " or " particular " or 
" individual " phases. 

8. Concluding Remarks on Morbid States 
223 Diseases are named : (1) according to the member 
affected (e.g. pleurisy, pneumonia, sciatica, podagra, nephritis 
arthritis, ophthalmia, etc.) ; (2) according to the chief symptom 
(epilepsy, spasm, tremor, paralysis, palpitation, cephalalgia 
otalgia, cardialgia, odontalgia, neuralgia; etc. (3) From the 
originating humour (e.g. atrabilious disorder) ; (4) from resem- 
blances to animals which the disease produces (e.g. leontiasis 
elephantiasis, satyrism) ; (5) from the first historical example of 
the disease ; Telephic ulcer— Telephus, son of Hercules 
wounded by Achilles' spear, but healed by its rust ; Chironia 
ulcer— Chiron, the first who successfully treated ulcers medically 
(6) according to the substance and essential nature of the disease 
— fever, inflammatory swelling-. 

224. Galen classified diseases into : (a) manifest or 
evident to the senses ; (b) hidden, or internal : (i) easy to recog- 



I? o THE CANON OF MEDICINE 

nize (e.g. gastric pains, lung pains) ; (ii) difficult to recognize 
because not evident to any of the senses (e.g. diseases of the liver 
or of the air passages within the lung) ; (in) only discernible 
bv careful judgment (disorders of the urinary passages). 

' 225 Diseases may occur in single members or in more . 
than one*. In the latter case there are the following possible 
relations : (i) association by natural connections ; ex. : stomach 
and brain, which are associated through nerves ; the uterus 
and breast which are connected by the veins. 

(ii) • One member is the channel for the other. 1 hus, the 
groin is the natural channel for inflammation to travel into the 
leg The weaker of two of so related members will take up ; 
the excrementitious matters from the stronger ; for instance, 
the axillary region from the heart. # 

(iii) Simple contiguity ; e.g. the neck and the brain. 

(iv) One member initiates the function of another. *or 
instance, the diaphragm is concerned in the drawing of air into 
the lungs (v) One member is the servant of another ; thus 
the nerves serve the brain, (vi) Some third member is associated 
with two related.organs. Thus, the brain is related to the kidney, 
and both these organs are related to the liver (Disease m one 
is likely to have deleterious effects on the others.) (vn) Vmous 
circles Disorder of the brain affects the activity of the stomach 
and impairs the digestion ; consequently the stomach supplies 
morbid vapours and imperfectly digested aliment to the brain 
so increasing the disorder of the brain. Hence from the original 
illness, the malady spreads and continues, and runs in a circuit. 

226. There are the following six degrees, ranging from. 

health to disease : 

i. Blameless health. 
1. Not absolute health. 

7 A state neither of health nor of disease, as people assert. 
% Potential illness ; where the body is on the verge of 
illness. 

5. Slight ill-health. 

6. Declared disease. 

227 Diseases are curable or incurable. A curable 
disease i°s one which offers no resistance to treatment. An 
incurable disease is one in which there is some impediment to 
complete cure, so that whatever the doctor applies, the desired 
effec? is not reached. For instance-headache which is due to 
" rheumatism." A disease is more likely to be curable whenthe 
temperament, the age, and the season are in proper relation.. 



THE CANON OF MEDICINE i 7 i 

If not, there must be a serious causal agent at work. One 
can only hope to cure . or 5 disperse the diseases of one season 
during the contrary season. 

228. Some diseases turn into new ones, and so themselves 
disappear. This is very satisfactory. One disease becomes the 
medicament for curing another. Thus, quartan malaria often cures 
epilepsy [cf. G.P.I.] also podagra, varices, and arthralgias. 
A spasmodic disease may be cured by scabies, pruritus, and 
furunculosis. A certain type of diarrhoea is cured by inflam- 
mation of the eyes. Lienteria cures pleurisy. Bleeding piles 
removes atrabilious disorders, including sciatica, renal and 
uterine pain. 

But the passage from one disease to another may be a serious 
matter. For instance, when an empyema spreads 'into the sub- 
stance of the lung ; when meningitis becomes lethargia. 
229. Transmission of disease from -person to person. 

A. Transmission by infection, (i) From one house to an 
adjoining one. Here belong, lepra, scabies, variola, pestilential 
fever, septic inflammatory swellings and ulcers ; (ii) from a house 
m the wind-track to another ; (iii) when one person gazes 
closely at another (e.g. ophthalmia) ; (iv) fancy : e.g. when a 
person's teeth chatter because he thinks of something sour ; 
(v) such diseases as phthisis, impetigo, leprosy. 

B. Hereditary transmissions* Vitiligo alba ; premature 
baldness ; gout : phthisis • lepra. 

Place in Family as a factor in the causation of disease {Lancet, 1928). 

C. Racial transmission. 

D. Endemic transmission. The sweating sickness of 
Angha ; elephantiasis in Alexandria ; aurigo in Apulia • 
endemic goitre, and many the like. ' 

230. Do not forget that weakness of members, and a frail 
body may supervene upon intemperaments. 

§173. This classification of the types of disease still holds good to-dav 
^trpXTog^alVndS^ dlferent ' b6CaUSe n ° W made more definite ^ in accord 
~t ^ S ° m t confusion as t0 the scope of the various terms still exists even in the minds 
a °i r t ^ aSe n W 5 h0 are n ° lo ^ students. Clinical and pathological conceptions d" not 
"^fLt " P a + ° n the ° ne hand ' there is an underlying endeavour to specify 
rl ,S'' and + *? se Parate out new entities in accordance with variations in the 
? ™ i manifestations In pathology, the distinction between general and special 
is more clearly adhered to, and the latter is described as much as possible according 
to the former— which is proper. s 

„i -^ J e S ard t0 an actual case before us, however, the pathology cannot be 
elucidated at once ; the clinical manifestations therefore receive the chief con- 
sideration. But such manifestations are limited in range, are of general character 
(universal, not particular), and should rank with genera in natural history the 
pathological character or process would furnish the specific name. Clinically, 



1 72 THE CANON OF MEDICINE 

diseases naturally comprise swellings, deformities, discolorations displacements, 
ulcerations, various solutions of continuity, aches and pains, and the like. Patho- 
logically, there are only four main groups of lesions— inflammations, new-growths, 
nutritional changes (degenerations and hypertrophies), and errors of development. 
(The short list presented by Avicenna is not a real fault, when considered from 
such a point of view.) If such a system cannot be allowed either by 'academic 
medicine or the laity (who insist on a " name " for a disease ) it has at least the 
advantage of enabling one to visualize from the first what is important to the patient 
and to concentrate on it. . 

The opposite procedure— that which rules the day— is that of describing 
diseases in all their forms and types, typhoid fever being awarded the crown The 
literature is always receiving reports on new types of disease. This method has the 
advantage of being capable of unlimited extension, for the number of types is (as 
should be obvious) exactly the same as the number of individuals affected thereby. 
In other words, all these types are simply the expressions of the individual s make-up 
and have nothing whatever to do with the infective organism, except m so far as it 
varies in virulence (i.e., in the composition of its " excreta "). ^ 

The idea that treatment cannot be correct unless the disease is correctly 
named is also very widely spread, and has the same effect— that of blinding the mmd 
to the real simplicity of truth. The unknowing abhors simplicity ; he ever seeks to 
" improve " — that is, to introduce more and more complexity. 



'W 1 ' 





THESIS II.— THE CAUSES OF DISEASE 
ETIOLOGY 

"Correlation, adverse or absent or excessive, between time, mental faculties 
and objects of the senses, constitute in brief the threefold causes of disease affecting 
either ^the body or mind." — (Charaka-Samhita 1 * 6 , i. 5.) 

" If the activity of the life-principle takes place in a harmonious and regular 
manner, unimpeded by any obstacles, such a state is called ' health.' If its activity 
is impeded by some cause, and if it acts abnormally, or irregularly, such a state is 
called disease. — (Paracelsus", p. 181.) 

i. Definition of Terms 

281. There are three groups of causes 
of those states of the body which have been 
referred to as : health, disease, a state 
intermediate. These groups are : (i) 
Primitive, or extra-corporeal causes. These 
befall the body from without (trauma, heat, 
cold). (2) Antecedent causes. These befall 
the body from within (repletion, starvation). 
(3) Conjoined causes. Here disease is pre- 
sent only as long as two causes occur at the same time. When 
either is absent, the diseased state comes to an end (e.g. sepsis, 
in fevers). 

The primitive causes are extra-corporeal ; namely : (a) 
from exterior agents, such as blows, exposure to very hot air, 
use of hot or cold viands ; (b) from the mind, which is here 
considered as distinct from the body. Here belong the causes 
of states of anger, fear, and the like. 

Other examples : privation of food, shelter, covering ; environment (monotony 
solitude, restraint, neglect, subjection, and their opposites). These are predisposing 

C3/QS6S. 

Resemblances. — The primitive causes resemble the ante- 
cedent in that there is a certain intermediate condition between 
each and the three states of the body named above. The 
primitive causes sometimes resemble the conjoined, in that there 
is no intermediate condition between them and the three states 
of the body. The antecedent and conjoined causes resemble 
one another in both being corporeal, or humoral ; that is, either 
temperamental or compositional. 

173 



I74 THE CANON OF MEDICINE 

Differences.— The antecedent differ from the primitive 
causes in being corporeal , and in requiring an intermediary 
between them and the bodily state. Such an intermediary is 
not necessary in the case of the primitive causes.— The conjoined 
causes differ from the primitive in being corporeal, but without 
an intermediary between them and the bodily state. An inter- 
mediary may occur, but is not essential in the case of the primitive 
causes.— The antecedent differ from the conjoined causes in 
that with the former the state does not become immediately 
manifest, but only after a number of other intermediate causes 
have come into operation, these being nearer to the state than 
are the antecedent causes. 

The above groupings of causes are the expression of a mode of 
thought now foreign to us. We seek more practical statements and 
rightly But when he thinks of causes, Avicenna goes back to 
fundamentals. This patient is before him, and the illness owes its 
origin to external factors which that patient cannot escape— the 
atmosphere, the weather, the climate, the drinking-water, the soil 
over which he lives and works ; or to factors operating within the 
body, producing aberrations in the physiological processes. 

The external factors naturally fall under the categories of the 
four elements (five, if we include " aether," represented by sunlight), 
and the memory is securely aided by thinking of each in turn.— 
The internal factors are classified according to the qualities— heat, 
cold, moisture, dryness. These also serve as aids to memory since 
many aberrations in physiological processes amount to disturbances 
in these several qualities in the different parts of the body. 

Changes of vitality as causes of disease are not here specified 
because they are secondary to the other causes It is true that 
disease is evidence of loss of vitality, of loss of radiance of the 
" breath " but this is the effect of " antecedent causes— repletion 
with humours ; depletion of humours ; and these again can be 
traced back to-interactions of qualities and changes in the proportions 
of the " elements." 

The following table is added for clearness : | 



Name of 
Cause. 



i. Primitive. 



2. Antecedent. 



3. Conjoined... 



Nature. 



Non-corporeal. 



(1) Corporeal (i.e., 
a humour). 

(2) Temperamental. 

(3) Compositional. 



Corporeal. 



Relation to 
bodily state. 



May be direct, or may 
only be through an 
intermediate state 



Is indirect, via an in- 
termediate state. 



Examples. 



Solar heat. 
Violent exercise. 
Heating articles of 
food (e.g., garlic). 
Sadness. 

Wakefulness. Blows. 
Cataract. Fever. 



Direct ; immediate. 



Suffusion of the orbits. 
Lachrymation. 
Repletion in fever. 



Blockage of an aper- 
ture by a humour. 

Blindness from ob- 
struction of the optic 
nerve . 

Sepsis with fever. 



T 



THE CANON OF MEDICINE 



l 1S 



232. Essential causes are such as pepper, which warms ; 
opium, which cools. Accidental causes are such as cold water, 
which warms because it closes the pores of the skin, and hence 
the heat is retained ; hot water, which cools because it opens 
the pores and liberates the heat ; scammony which cools by 
expelling the calefacient humour. 

An essential cause is one which alters the." nature " ; that is, that on which 
the primary qualities of the body (heat, cold, moisture, dryness) depend. 

233. ^ It does not follow that a causal agent will alter the 
body even if it reaches it. Before the agent can act one of three 
conditions must be fulfilled, (i) The agent must be powerful 
enough ; (2) the preparatory power of the body must be ade- 
quate ; (3) there must be an appropriate time-factor. The agent 
must be exposed to the causative agent long enough for the 
latter to act. The states of the causes vary in their results. One 
single causal agent may give rise to quite different diseases in 
different persons, or at different times. 

The_ Time-factor.— The time occupied before a given agent can produce its 
effect varies with different individuals, just as some persons have a long digestive 
time-factor and others a short one. This was spoken of very long ago (Charaka 155 
ii. 793) ; the lesson being, in the case of digestion, that the number of meals per 
day should depend on the time-factor and not on popular custom 



A. UNAVOIDABLE CAUSES OF DISEASE 

(i) Extracorporeal 

2. The Atmospheric Air and its Influence within the 

Body 

■ IR (234) is an element which is in our body and 
in_ our breath (ruh). It is also continually 
being contributed to the breath. It is the 
agent which modifies the breath, not simply as 
element, but in virtue of its constructive and 
attempering nature. 

235. We have made it clear already, and 
emphasize it again here, that the term " breath " is not synonymous 
with what philosophers (and theologians) term " soul" 

236. There are two processes whereby the breath reaches 
its attempered state from the air — namely depuration and ven- 
tilation. Ventilation is the means whereby the temperament of 
the breath is modified in respect of the undue warmth which is 




i 7 6 THE CANON OF MEDICINE 

usually the effect of condensation and imprisonment of the breath. 
(By temperament we mean that relative temperament which has 
been denned for you.) This attempering is attained by means of 
the air drawn in at the lungs and the pores of the skin, and by 
means of the distribution of that air through the arteries by means 
of their pulsation. 

237. Compared with the temperament inherent in the 
breath, the air around us is very much cooler than it is compared 
with the temperament arising from the imprisonment or con- 
densation of the breath. When the outer air enters the breath, 
it drives it on and mingles with it, and so prevents its trans- 
formation into the astringent fire-element ; for such a transform- 
ation would render the temperament of the breath faulty and 
unfitted for receiving the impressions of the sensitive soul 
(i.e. for maintaining life), and would interfere with the dispersal 
of the moist vapour of the substance of the breath. 

238. Depuration is the process going on during expiration, 
and by it the separation of the fuliginous vapour in the breath is 
secured. The fuliginous vapour is to the breath what superfluous 
humour is to the body, and it is expelled (as bad air). During in- 
spiration, the air enters into, pervades, and aerates the breath ; 
during expiration, the breath is purified into the air. (In this way 
the temperament of the breath is maintained.) 

239. When the air is first drawn in, it necessarily cools 
the breath, but after the air attains the quality of the breath, 
through continued contact with its heat, it ceases to be an 
adjuvant, and is superfluous. Hence new air is needed, and 
when breathed in supplies the place of the other. The old air 
must be expired in order to give place for the new, and at the 
same time remove with it the superfluities of the substance of 
the breath* 

240. As long as the air is attempered and pure, and has no 
substances admixed which would be contrary to the temperament 
of the breath, health will come and remain. Otherwise the 
contrary occurs. 

241. The air is liable to natural as well as non-natural 
changes, and may even undergo preternatural changes. The 
natural changes are those of the seasons. At every season the 
air changes to a new temperament. 

* It appears that the idea of gaseous interchange within the lung was not 
grasped What we know as " residual air " comes to be what Avicenna speaks of 
as "breath " (ruh). Hence the description in the text is right m idea, but lacking 
in exactitude. 



THE CANON OF MEDICINE I?7 

/M n ^i US l e markS J^* the air is diffe rent in character (a) at the seasons of the 
year (6 1 at the changes of the moon, (b >) at the rising and setting of the stars A^inerpf 

(fl) NATURAL MUTATIONS 

3. The Influence of the Seasons on the Atmosphere 

242._ _ The word " Season " has a different meaning for 
the physician than for the astronomer. According to the 
astronomer, there are four seasons, which are reckoned according 
to the position of the sun in the zodiac. According to the 
physician, spring-time, in temperate climates, is the time when 
warm clothes are less necessary, and yet no precautions are 
required against heat. The trees begin to leaf at this season. 
It is the time of flowers and leaves, and the beginning of the 
formation of fruits. To be more exact, it is the portion of the 
year between (or about, or slightly before, or slightly after) 
the vernal equinox and that at which the sun has reached the 
middle of Taurus. 

Autumn is the opposite portion of the year in our latitude.§ 

§ This chapter is taken by Andreas de Alpago Bellunensis as the nmnf +w 
Avicenna was a native of Persia, (cf. footnote to 369). eUUnenSls as the P roof that 

_ It is the time of change of colour in the leaves, and the 
beginning of their fall from the trees. 

later ^ ^^ C ° UntrieS S P rin £ ma ^ come sooner and autumn 

The summer and winter, from the point of view of medicine 
are the portions of the year remaining— and the interval between 
spring and autumn is much shorter than that between autumn 
and spring. 

Summer is the whole of the hot season, and winter the whole 
of the cold season It is the season opposite to summer, beincr 
less or greater m duration according to the latitude.* & 

" weak"Ta e sons nd "^ "* ^ " Str0ng " SeaSOnS < S ^ and autumn are the 

243. The temperament of spring is equable, and not hot 
and moist as some think. The proof of this rests with natural 
philosophy. 

The temperament of summer is hot, because the sun is 

* This passage is slightly rearranged. 



N 



i 7 8 THE CANON OF MEDICINE 

nearly vertical, over our heads, at this period. The power of 
the rays of the sun may be. thought of as being concentrated in 
summer because instead of being refracted they form only a 
very acute angle, or are reflected back along the line of incidence 
itself. The effect is different according as the solar ray is axial, 
like the -axis of a column or pyramid (in which case the ray is 
thought of as coming from the centre of the sun into an exactly 
opposite spot on the earth's surface), or is oblique. The axial 
rav is stronger because its impression is added to by the incoming 
rays from all other points. The oblique rays are the weakest 
(because in this case rays from other points do not join and add 
to them). In summer we are exposed to rays almost or quite 
axial. This is the longest season in our (southerly) climes. In 
winter the rays are nearly circumferential (tangential, oblique). 

244 In summer the light is very intense, and yet the sun 
is more distant from the earth, for the sun is on the increase 
However, I discuss the subject of the distance or nearness of 
the sun in the astronomical section of my book on mathematical 
philosophy. The proof of the intensity of the heat and of the 
lio-ht of the sun is set forth in my book on natural philosophy. 

b 245 Influence of summer. Summer makes the air hot and 
dry, because (i) its great heat disperses the water vapour ; 
(2) it attenuates the " substance " of the air, and makes it more 
like " fire " ; (3) there is little in the air at this season to separate 
out as rain or dew. . 

246. Influence of winter. Winter makes the air cold 
and moist, for contrary reasons. 

247= Influence of autumn. In autumn, the heat subsides 
and the cold is not yet'at its greatest because we live at a latitude 
where the rays are between the equatorial axis already referred 
to and the circumference. That is why the temperament of the 
air is between hot and cold, but not between moisture and dryness. 
When the sun has rendered the air dry, how could there remain 
behind in the air any humectants which would counteract the 
source of desiccation ? 

248. A state of the air tending towards coolness is not 
like one tending to moisture, because the change to cold is only 
slight, whereas the change to moisture is further. The change 
towards moisture which coolness induces is not as easily effected 
as one towards dryness, which heat induces. The latter is facili- 
tated by heat because heat itself is a drying agent. Coldness is 
not a humectant. Humectation is facilitated by a certain degree 
of heat provided there is some substance present which possesses 



THE CANON OF MEDICINE 179 

a certain degree of coldness. A certain amount of heat allows 
evaporation, but does not disperse (water vapour) ; and there 
is a certain amount of cold which is inadequate for bringing about 
inspissation, cohesion, or union. 

249. Consequently, the state which enables the air of 
spring to remain at the same degree of moisture as in winter is not 
like the state which enables the air of autumn to remain at the 
same degree of dryness as in summer. The moisture of the air 
in spring is attempered by heat as much as the dryness of air 
in autumn is not modified by cold. Moisture and desiccation, 
therefore, are alike in regard to the action of " habit " and 
privation but not in regard to the action of their respective 
contraries. For, in this case, desiccation is simply " destruction 
of- moist substance " ; but humectation is not " destruction of 
dry substance," but " acquisition of moisture." 

250. In speaking here of air as being "moist" or "dry" 
we do not, of course, refer to " form " or " natural quality." 
Such a question is remote from our present purpose. In calling 
air " moist " we mean that much aqueous vapour is admixed 
with it, or that its density has reached that of aqueous vapour. 
In calling air " dry," we imply (i) that the aqueous vapour 
formerly present has been dispersed, or (ii) that the air has 
become rarefied or attenuated until it comes to resemble the 
substance of Fire, or (iii) an air with which earthy vapours 
(which resemble Earth in being dry) are admixed. 

251. Consequently, the moisture in the atmosphere 
which remains over from the winter is lessened in spring bv a 
certain amount of heat accruing to it by the fact that the sun is 
approaching the middle of the heavens, and coming to be nearly 
overhead. But the dryness which remains over from the autumn 
does not encounter any moisture from the approaching coldness 
of the winter. 

252. Further, would dry things become moist as quicklv 
in cold air as moist ones would become dry in hot air, supposing 
the ratio between the cold and coldness to be about the same as 
that between heat and hotness ? Obviously there would be a 
difference. 

253. A third and better argument is that moisture cannot 
remain longer in hot air than in cold unless it were continually 
being reinforced by further additions of watery vapours. Dry- 
ness, however, needs not such continual emanation for its main- 
tenance. 

254. The reason why moisture disappears from bodies 



i8o THE CANON OF MEDICINE 

exposed to the air, or from the air itself, unless there is a continual 
reinforcement with further moisture, is that air is only cold in 
comparison with our body/ It is not sufficiently cold in the places 
we inhabit to enable the moisture to be dispersed from the 
atmosphere. It is the power of the sun and the stars which 
disperses it. Consequently, though the supply of _ moisture 
ceases, the dispersal goes on until a state of dryness is rapidly 
reached. 

255. The atmosphere in spring. In spring, there is more 
loss by dispersal than by evaporation. The reason is (i) there 
is little heat, and that is dispersed widely in the atmosphere ; 
(2) much heat is shut up in the bowels of the earth. Hence 
rarefied vapours are continually being breathed out towards the 
earth's surface.* 

256. The atmosphere in winter. During winter the amount 
of heat concealed within the earth is very great — as is proved in 
treatises on natural science — whereas there is only a negligible 
amount of heat in the atmosphere. So there are two factors which 
together contribute to moisten the air — sublimation and con- 
densation. This is the more so, because the substance of the air 
in winter is so cold that it becomes more dense, and adaptable 
for evaporation. 

257. In spring, attenuation (dispersion) in the atmosphere 
exceeds evaporation. There is much less heat concealed in the 
earth. This is clear from the fact that something suddenly 
comes to the earth's surface at this timet which is more potent 
than the evaporating or the rarefying agent. This great access 
of material delays the evaporating process, and brings the 
(moisture) longer into contact with the abundant atmospheric 
heat ; and this completes the dispersion of the moisture. 

This is the chief explanation of the fact that the vernal 
air fails to retain the bulk of the winter moisture, and that the 
autumnal air fails to retain the bulk of the summer dryness — ■ 
apart from other reasons over and above what we have named. 

Furthermore, there is not enough material to replace what 
has been sublimated and rarefied. The result is that the nature 
of spring necessarily tends to an equipoise between moisture and 

* Note the accuracy of this conception. 

The fancy or j est that summer -heat and winter-cold are the result of the 
greatness of the boiling of ' Hell ' (i.e., the interior of the earth) makes a breathing 
twice a year, expiring in summer and inspiring in the winter " (Night, 487, Burton) 
may be here recalled. . ,, 

t " The vapours of the sky descend, and vapours rise up out 01 the eartn ^ 
(in spring). "The two co-operate in the work of renascence of vegetable hie 
(Li Ki, IV, i. 14). 



THE CANON OF MEDICINE 181 

dryness, as much as it does to one between heat and cold. Still, 
one cannot deny that in spring there is at first a tendency to 
a certain degree of moisture. But in spring the moisture is 
nearly at equipoise, just as in autumn the dryness is nearly at 
equipoise. Even if there is in autumn not an exact equipoise 
between heat and cold, it will not be far from that, because in 
autumn the periods of the day just before and just after noon are 
like those in summer. The autumnal air, you see, is very dry, 
and can readily become warm and fire-like, summer having 
already disposed it to be so. But the nights and morning hours 
in autumn are frosty, owing to the obliquity of the sun's rays, and 
also_ because the tenuous matter in it is well disposed to undergo 
infrigidation. 

Spring air has these two qualities in almost exact equipoise, 
because its^ air does not take up the heat and cold which the 
autumnal air so easily receives. That explains why the autumn 
night is not very different from the autumnal day. And if 
anyone should ask for why is an autumn night colder than a 
spring night, as one would expect the atmosphere to be then 
hotter, because it is so attenuated — he may have the reply that 
extremely attenuated air becomes hot or cold more quickly, 
exactly as does extremely rarefied water. For, if vou heat 
water> and then wish to freeze it, it will do so more quickly than 
cold water would, because the cold penetrates more easily 
between the particles separated from one another by the pre- 
ceding heat. 

258. _ The human body is not as sensitive to the cold of 
spring as it is to that of autumn, because in spring the body 
passes from a coldness to which it is already acclimatised, to an 
increasing warmth. In autumn, the reverse is the case, for 
after being relaxed by the summer heat, the body is suddenly hit 
by cold ; this in spite of the fact that autumn approaches winter, 
whereas spring recedes from it. 

259. Change of seasons has to do with the kind of diseases 
peculiar to each climate. Consequently the prudent physician 
will carefully study his own climate (atmospheric conditions 
day by day and month by month) and country in order the 
better to treat the diseases and maintain his patient's health by 
an appropriate mode of life, and (in order the better to choose) 
the regiminal measures appropriate to that climate and 
country. 

260. Sometimes one day of a season is like some one day 
of another season ; and sometimes it is not. Some days in 



1 82 THE CANON OF MEDICINE 

winter are spring-like ; some spring days are summer-like ; 
some days in autumn are hot and cold during the course of a 
single day. 



§ 174. The changes which the seasons produce on the human 
body are ascribed in this chapter at least in part to the changes which 
the seasons produce in the ground itself. We are introduced to 
the idea of " ground-air," " ground- water," " ground-fire (mod. 
ground-temperature). That which the Canon here hints at is 
found to be entirely accurate in the light of modern investigations. 

8 175 Movement of ground-air. In the interstices of the 
soil there is an abundance of " vapour," which moves in and out of 
the earth into the atmosphere, as the ground-water moves up and 
down. We may rightly picture the earth as a huge lung. It 
exhales ground-air into the air we breathe, and if the former is 
humid, owing to a high ground-water level, the exhaled air will be 
" damp " • if the temperature of the earth be low, the exhaled air 
will be cold ; if the ground-air be polluted the air we breathe will 
become fouled. The conception of the earth as a lung is given in 
almost those very words by Avicenna (255). 

§ 176. Movement of ground-water. The ground-water may 
move merely up and down, or it may travel horizontally even to great 
distances. Its height varies with the rains, the season, the nature 
of the rock beneath, the character of the subsoil, and the presence of 
vegetation (crops, undergrowth, woodland, forestland). The move- 
ment up and down may be compared with tidal movements. The 
"waters under the earth" move, as do the seas. Clearly, then, 
floods and droughts, swampland and gravelly land, all have wide 
effects. The interference with vegetation' also alters natural con- 
ditions, whether beneficially or detrimentally to human welfare. 
Lane-Notter (Enc. Brit. 25, p. 348), states that it has been estimated 
that an acre of cabbages will absorb from the land, and transpire 
from its leaves more than ten tons of water per day, when the weather 
is fine. The destruction of trees arrests the upward movement of 
ground-water, which previously was carried high up into the air 
as if by so many chimneys, and so affects other places at considerable 

c\\ sf3.11.CGS 

§177. Practical bearing of these facts. Innumerable living 
things pass the whole, or part of their lives in the ground-water. 
They are carried along with it, both to the surface, and horizontally 
underground, possibly to great distances. The following groups 
may be specified : (1) Bacteria. These are derived from (a) the 
earth's surface from refuse in the neighbourhood of habitations, from 
excreta, trade-effluents, slaughter-houses, (b) deeper strata: cess- 
pools, which do not necessarily filter off the organisms. (2) Protozoa. 
(3) Moulds and spore-bearing organisms generally. (4) Inverte- 
brates of many orders. 

These all flourish according to the presence of putrefactive 



THE CANON OF MEDICINE 183 

matters in the soil (vegetable or animal), according to the ground- 
temperature, and according to degrees of anaerobic state (which has 
to do with cycles of development). 

" The earth, is a great stomach, in which everything is dissolved, digested and 
transformed, and each being draws its nutriment from the earth; an I elch living 
being is a stomach that serves as a tomb for other forms, and from which new form! 
spring into existence."— (Paracelsus, Paramirum" p. 205.) 

Organisms gain access to the human body (a) directly from the 
surface soil, from the drinking water, from insufficiently cleansed 
vegetable foods, m partly decayed vegetables or vegetables which have 
become stale m the markets, from the inhalation of infected dust 
(especially the dust of earth pulverised by being parched in times of 
drought), (J,) indirectly, by contamination of food by insects whose 
larvae infest the soil to an extraordinary extent ; by use of vegetables 
infected by invertebrates which themselves harbour pathogenic 
organisms. b 

§ 178. Diseases associated with ground-water. Damp soil 
favours putrefaction, with ultimate pollution of the air Phthisis is 
favoured m such localities. When the soil is actually wet, from the 
rising of the ground-water, typhoid epidemics have been noted 
(Pettenkofer). Fleas on rats which burrow into soil polluted by 
plague-infected ground- water become infected themselves. 
n 1 J : l 9 'r Diseases associated with variations of earth-temperature 
Cold soil favours bronchitis and other chest complaints Warm soil 
favours the multiplication of certain organisms— those which 
flourish best at certain temperatures, and anaerobically. ^Favoured 
by admixture of the soil with manure.) ^ 

§ 180. The subject is therefore plainly of importance both in 
regard to the study of pandemics, epidemics and endemic diseases 
and m regard to the daily condition of the individual patient, the 
progress of his disease, and even the exact form which a disease takes 
in his case. As Avicenna says, the practitioner would benefit by 
noting the successions of weather-changes, the type of the season and 
the seasonal cycles, especially interpreted in terms of movements of 
the water, air, and " fire " in the earth. 

4. The Influence of Seasonal Changes on the Body 
261. When a season is harmonious* for a person of 
healthy temperament, it is appropriate for him, but not so if the 

x, cct " ! ia ™ onious -''— Cf. " conformity with the laws of nature '* (Li Ki » VI 
P l 535) ' + t£ case the season is considered as the variable, and the human tem- 

perament the constant. But it may be noted that the whole of our life is a matter 
of conformity with the laws of nature," from highest to lowest. If the ''Govern- 
ment conforms in all respects, thus exhibiting the Great Conformity— requiring 
m o S lH r ^ mdS a + f M a 1 6r wills ~ and if e ach individual in turn conforms! the E? 
I°S inSn,i e ^ eal State - rhe *PP^°K ^ regard to the incidence of Leal 
m the individual being is very wide, and this section of the Canon becomes sue- 

fsScIaVo nwi n th S 1 t: reStmg "^ Whm *" QaSSiC jUSt 1 uoted is «Sd L 



l84 THE CANON OF MEDICINE 

person is of unhealthy temperament. But* if deviation from 
equipoise be marked, then the season will be harmonious or not 
correspondingly, but the person may become debilitated.? 
When a season is appropriate for a person of unhealthy tempera- 
ment, the contrary holds. 

262 When the nature of two seasons at the commence- 
ment is opposite to that at their termination, and yet the altera- 
tion from the mean is not great (because not of long duration), 
as, for example, when a southerly winter is followed by a norther- 
ly spring the second season will be more beneficial to the human 
body than the first, and will attemper the body. This is because 
the northerly spring is opposite in action to the southerly winter. 
If the winter be very dry and the spring very wet, the latter 
modifies the dryness of the former. But if the spring is not 
very humid and does not last long, then its modifying moistening 
influence will not be deleterious. _ _ . 

263 A single seasonal change is less injurious to lite than 
are repeated changes— supposing the change m question is 
liable to prove mortal, and not one which reverses a previous 

264 Among the temperaments of the atmosphere one 
that is hot and moist is more favourable to putrefactive pro- 



cesses. 



265 Atmospheric changes are common in some regions, 
especially in the depths of the valleys ; they are only rare on 
hills and high mountains. . 

266 It is better when seasons are normal in character ; 
it is better that summer should be hot and the winter cold ; so 
with each season. If seasons are not normal in character, 
serious maladies will arise. 

267 If all the seasons in one year are of uniform quality 
(for instance, wet, dry, hot, cold, all through the year) it is a bad 
year ■ there will be many diseases in conformity with the quality 
of the year. The subsequent seasons will be fortunate, lr a 
single season can arouse much illness of corresponding type, how 
much the more will not a whole year arouse ? _ 

268 A person of phlegmatic temperament is liable to 
develop epilepsy, paralysis, apoplexy, trismus, convulsions and 

the like, in a cold season. 

269 A person of choleric temperament may develop 
delirium 5 S mania, acute fevers, acute inflammatory swellings tn a 

* i.e., Taking the human nature as the variable, and the laws of nature as the 
constant^ ■ ^ non _ proportional season would make a very non-equable person weak. 



'F 



THE CANON OF MEDICINE 185 

hot season. How much the worse would it not be if the character 
of that season persisted throughout a whole year ? 

270. _ With a premature winter, winterly diseases come on 
early. _ With a premature summer, summer diseases arise early. 
The diseases of the corresponding season will change accord- 
m gty- . 

271. An unduly prolonged season predisposes to many 
illnesses, especially in the case of summer and autumn. 

272. Note that the effects of the changing seasons are not 
due to the season itself, but to the quality which is changed along 
with them, for this exerts a marked effect upon the states of the 
body. A change from heat to cold in the course of a single day, 
produces a change in the body accordingly. 

273. A rainy autumn followed by a temperate winter (not 
without some cold, and yet not too cold, considering the geo- 
graphical region) is more healthy. A rainy soring followed by 
a moderately rainy summer would be more likely to be healthy. 

See also 581, where the effect of the seasons on the pulse is discussed. 

5. The Properties of Healthy Air 

274. The substance of the air is good when (i) it is not 
contaminated with extraneous matter, such as the vapours [from 
marshes or lakes, or from canals or open sewers : Aegineta ; 
or the gaseous products from chemical works, etc. : modern]' 
or smoke and soot.* (2) It is open to the sky [i.e. not shut in 
by high mountains: Aegineta; and, generally, is able to circulate 
freely round us : Nash]. (3) Is not confined in caves [cf. 
Grotto del Cane], or between high walls, or shut up in houses (or 
m underground cisterns). 

275. Once a putrefactive process has begun in the air, it is 
more likely to continue if the air is free and exposed than when 
it is enclosed and concealed. Except for that, it is better that 
air should be free and exposed. 

276. Healthy air remains clear unless there be admixed 
with it vapours from lakes or from stagnant and deep waters or 

marshy lands, or from places where potherbs are cultivated 

especially cabbages and herb rocket ; or where certain resinous 
trees or trees of bad temperament (box, yew) grow, or where nuts 
or figs grow, or where there are offensive odours and evil-smelling 

* ° n <r may ai S o add: germ-laden dust, or particles of saliva and exhaled 
particles of moisture charged with possibly pathogenic microbes. Note that ex- 

of Ht^^T a ^ S °' 5 I" C ! nt - ° f ° rganic im P»riti^ which are much more a source 
of disease than the carbon dioxide gas produced by respiration. 



l86 THE CANON OF MEDICINE 

winds. In short, the air remains clear if healthy winds, coming 

from high or level ground, blow over the district. 

Such air is not retained deep in the earth. It becomes 
warm quickly after sunrise, and becomes cold quickly after the 
sun has set. The air found confined within the walls of recently 
built houses, is not likely to be healthy, as the air is not quite dry 
owins to the lime in the walls. 

Air is good when it does not interfere with one s breathing 
or cause the throat to contract. . . 

277 You have already learnt that changes occur in the air 
which are (i) in accord with its nature, (2) contrary to its nature 
(preternatural), (3) neither the one nor the other. _ 

Of the changes in the atmosphere which are not in accord 
with its nature, these are either contrary to or not contrary to it. 
Sometimes the changes run in cycles, sometimes not ; they may 
occur at certain seasons ; they may be periodic, and sometimes 

n0t " It is more healthy if the seasons accord with the nature of 
the atmosphere, for otherwise illnesses come about. 

S 181 The effects of the different climates (hot, cold, damp, 
drv) on the body, and the diseases associated with each are given by 
various ancient writers, but the statements often *? *7™<* ™* 
one another. It is sufficient to consider the possibility that, apart 
Tom infective agents, the temperature and humidity of a region 
afferts the nutrition of the body, the vigour of the body and is 
accompanied by liability of certain organs to disease (gastric, 

^^uS£tf thefts been studied in modern times in its 
relation to liability to induce disease The average normal re ative 
humiditv is 75 per cent. ; excess of moisture makes the air leei 
chSy Mists are detrimental because they absorb the warming rays 

° f ^Stagnant air produces " stuffiness," for instance in rooms. This, 
is due to the air heated by the skin remaining close to the skin and 
preventing the latter from cooling. The surface circulation fads to 
receive its proper stimulus in consequence. 123 (p. 120.) 

The following passage in the Su-wen is of interest : Huang 
Ti asked in what dinner cold and heat, dryness and moisture, wind 
and fire operated on man, and how they produced the transformation 
of all things " Ctii Po replied : "... the Five Fluids come for- 
ward in turn, and each of them takes precedence once. When they 
lonot keep in their proper spheres there is disaster when they do, 
everything is well ordered," etc. (Forke, 23 p. 250-252.) 



THE CANON OF MEDICINE 187 

6. The Influence of the Changes in the Quality of the 
Atmosphere ; the Diseases incident to the Several Seasons 
and Kinds of Weather 

278. Hot atmosphere. A hot atmosphere disperses the 
breath and has a relaxing effect. A moderate degree of heat 
induces redness by drawing blood to the surface of the body. 
A great degree of heat results in a yellow colour because it breaks 
down (the components of) the blood which has been drawn to the 
cutaneous vessels. It also evokes sweating, diminishes the 
amount of urine, impairs the digestion and induces thirst. 

Cold atmosphere. A cold atmosphere has a constricting 
effect. It strengthens the digestion, and increases the amount 
cf urine. The reason for the latter is that it causes the humours 
to become imprisoned, so that only a small portion of them can 
become resolved into sweat. Another reason is given presently. 
Cold induces constipation because the anal muscles remain 
tightly contracted and the rectum does not respond to the call of 
the intestines ; hence the faeces linger long in the intestines 
instead of descending (out of. the sigmoid), and their watery 
constituent is re-absorbed and passes into the urine. 

Moist atmosphere. This has a softening effect on the skin, 
and renders the body moist as a whole. 

Dry atmosphere. This has a drying effect on the skin, and 
renders it rough and dusky. 

279. Fogs. — Foggy air has a depressing effect on the mind, 
and disturbs and confuses the humours. This kind of air is not 
the same as " dense " air, for the latter is dense in substance, 
whereas foggy air is so because the particles with which it is 
mingled are coarse (nearly or actually visible). The sign of such 
an air is that stars of small magnitude are scarcely seen through 
it, and even the brilliance of the planets is reduced to the lumino- 
sity of fixed stars. Murky air is produced (when it is very cold) 
by the presence of much fuliginous vapour, and of smoke, or by 
absence of good winds. 

This will ^ suffice about this subject for the present ; we 
shall return to it later in speaking of preternatural changes in the 



air 



280. The Seasons. Every season has its own proper 
characteristics. The characters occurring at the end of one 
season, and the diseases associated with this, agree with those 
occurring at the beginning of the next season. 



1 88 THE CANON OF MEDICINE 

Changes' which Spring produces in the Body. 

281. When the temperament of the spring conforms to 
type, it is a very healthy season ; its temperament corresponds to 
that of the breath and of the blood, although the fact of its being 
in equipoise, as already explained, makes it tend towards the 
tenuity and enervating character of hot air, and also towards 
moisture. It renders the skin ruddy by drawing the blood to the 
surface to a moderate degree, and yet it does not effect that degree 
of dispersal of the breath which an over hot summer does. 

At this season of the year, the humours of the body, hitherto 
stagnant, bestir themselves and circulate. Chronic disorders are 
therefore met with. In persons of atrabilious temperament the 
atrabilious humour comes into activity. Persons who have over- 
fed during the winter without taking much exercise, so that the 
humours are redundant, are liable to spring-time diseases 
because these immature humours now become active and dis- 
seminated (through the tissues). 

A spring which is prolonged without losing its attempered 
character will be followed by few diseases in summer. 

282. The diseases of spring. Nosebleeding, effusion of 
blood, fermentation in the atrabilious humour or in the bilious 
humour. Inflammatory deposits ; carbuncles ; anginas (which 
may be of severe type); abscesses of various kinds. Varicose 
veins may " burst," there may be haemoptysis, and a cough 
becomes increasingly troublesome especially if the early part of 
spring be winterly.. Those persons who have such disorders, 
and most of all, phthisis, will be in a worse state. 

[Bronchitis, Bronchopneumonia, Influenza. In early spring : Measles.] 

In persons of a phlegmatic constitution, the season of spring 
brings movement of the serous humour, and there is a tendency 
to apoplexy, paralysis, and joint trouble. Such disorders are 
more likely to arise if there be any vigorous corporeal or psychic 
movement (emotion), or if calefacient articles of food are included 
in the diet, for all these enhance the effect of the atmosphere at 
this season. 

The most efficient means of averting maladies incident 
to spring : venesection ; purgation ; semi-starvation, or res- 
triction of food, increasing the fluids (especially_ syrups), but 
reducing the intoxicating liquors, and even then taking them only 

diluted. 

283. Relation to periods of life. Puberty and the time ot 
life thereabout are benefited by spring-time. 



THE CANON OF MEDICINE 189 

Changes which Summer produces in the Body. 

284. In summertime* : the humours are dispersed ; the 
faculties and natural functions are impaired owing to the exces- 
sive dispersion. The bloodf and serous humour are diminished 
in amount ; the bilious humour increases in amount ; and 
towards the end of the summer, the atrabilious humour increases 
in amount as a result of the dispersion of the attenuated matters, 
whereby the heavier particles stay behind in increasing amount! 
This is why old persons and those of similar nature feel stronger 
in summer. 

The colour of the body becomes citron-yellow as a result of 
the dispersal of that which the summer heat draws out of the 
(surface) blood. 

285. Effect of Summer on the course of diseases. — In summer- 
cime diseases show shorter stages. For, on the one hand, in 
robust persons, the warm air helps to disperse and mature 'the 
disease-matter, and also discharges it from the body. On the 
other hand, in weakly persons, the atmospheric heat only 
adds to their weakness by its relaxing influence. The sick 
person will therefore lose his strength and die. Further- 
more, if the summer be hot and dry, illnesses are quickly broken 
up ; whereas if it be wet, the humours becomes glutinous in 
character, the stages of the diseases are prolonged, and recovery 
is delayed. In that case the disease comes to be of long duration. 
For instance, a simple ulcer may become obstinate, may spread, 
and may deepen. Dropsy and lienteric diarrhoea, and looseness 
of the bowels are liable to occur. This is all because of the flow of 
redundant humours downwards from the upper parts to the lower. 

288. Diseases specially associated with the hot season. If 
very hot : tertian, continued, and burning fevers ; emaciation - y 
pains in the ears ; ophthalmia. If cupping be not done \ 
erysipelas is common ; also furunculosis/ (These are of like 
nature to summer.) If spring-like : mild benign fevers, in 
which the tongue and fauces do not become rough and harsh, 
and there is no dryness of skin. This, is because the sweating 
continues m plenty, especially at the crisis. For the heat and 
moisture co-operate with it — and the former resolves the humours, 
the latter softens the skin and opens the pores. 
_ _ If southerly : deaths are frequent. Variola, morbilli, and 
similar serious diseases are common. 

August £ in Se'fembef ° Und ^^^ 1S hi S hest ^ to <* <*eg. F. at the end of 
+ The blood is ** thin " in summer ; " thick " in autumn. 



1 9 o THE CANOH OF MEDICINE 

If northerly : this is favourable to health. If diseases 
arise, they are diseases of " expression " ; that is, disease-matter 
is caused to circulate by the action of the innate heat as well as by 
the exterior heat ; then, being exposed to the cold atmosphere, 
it is expressed from the body. This occurs in rheumatisms, 
catarrhs, and their sequelae. 

If northerly and also dry : this is beneficial for persons ot 
phlegmatic constitution, and also for women. Persons of bilious 
constitution are liable to develop eye-trouble, acute fevers of long 
duration, and diseases due to the oxidation of an excess of bilious 
humour (which has accumulated in such persons), and diseases 
arising from a redundance of the atrabilious humour. 

rSummer diarrhoea, and bowel diseases, and enteric] 

f™ That the frequency of disease in hot weather is to be partly ascribed 
to the § multiplication of flies under the favouring influence of the ground heat a^ 
warm air was of course not known in Avicenna s time On the other hand the 
c?us™ of souring of milk in hot weather is still not understood, and the incidence of 
some febrile conditions is parallel. 

Changes which Autumn produces in the Body. 
287 e The autumn season brings many diseases for these 
reasons :* (i) there is exposure to a hot sun by day, and the 
nights are cold. (2) The humours are vitiated by the following : 
(i) abundance of fruits in the dietary, (ii) bad articles of diet, 
(iii) dispersion of attenuated matter, leaving dense particles 
behind and these then undergo oxidation, (iv) in summer the 
fermenting humours pass to the skin and the natural faculties 
can be brought to bear on them so as to disperse and expel 
them • but in autumn, the cold atmosphere causes the humours 
to be thrown back into the interior parts, where they accumulate 
and are (as it were) imprisoned. (3) The vigour of the body 
has been impaired by the preceding summer. 

288, In autumn, the blood is much less in amount because 
this season is contrary in temperament to the blood. Conse- 
quently it cannot help blood to form, and that which the summer 
has alreadv dispersed is not replaced. On the other hand, the 
bilious humour becomes relatively increased during the summer, 
and predominates during autumn. The atrabilious humour is 
more abundant at the end of summer because of the oxidation _ or 
the humours during summer, and this produces ash-like 
residues, which tend to sediment under the influence of the 

autumnal cold. 

289. List of autumnal diseases and disorders. (1) Severs : 
composite ; quartan— due to abundance of atrabilious humour 
and the agent already described ; associated effects —enlarge- 



THE CANON OF MEDICINE 191 

ment of the spleen, oliguria (the urine only passes drop by drop 
owing to the temperament ofthe blood being diverse — between 
heat and coldness), dysuria (partly because the urine only comes 
drop by drop), lienteria (because the cold drives the -rarefied 
portions of the humours into the interior parts of the body) ; 
simple hectic fever ; this is more severe during this season 
because it is desiccant in character. 

[Scarlet fever : diphtheria.] 

(ii.) Diseases of the individual organs. — Skin : impetigo, 
excoriating scabies ; " canker"; pustules (especially if the 
autumn be dry and the preceding summer was hot).— '-Throat : 
acute " choleric " angina. 

(Cf. the corresponding disease in spring, in this case due to serous humour 
the reason of the difference of humour in the two forms lies in the fact that the 
season preceding in each case favoured the prevalence of that humour, and it is this 
that constitutes the " soil " upon which the anginal infection thrives.) 

Lung : Autumntide is harmful for persons suffering from 
phthisis and chronic pulmonary affections. If a person had such 
a disease latent in him at the onset of autumn, he would show the 
signs of it at the end of the season. Brain : apoplexy ; mental 
disease is common because the bilious humour is unhealthy and 
atrabilious humours are admixed with it. 

\_Intestinal tract : diarrhoea, etc.] 

(lii.) Pains : in the joints ; sciatica ; pains in the back 
and hips (due to the stagnation and subsequent imprisonment 
of the_ insoluble parts of the humours which summer brought 
into circulation). 

Worms. — These multiply because digestion is deficient, 
and there is lack of expulsive action. 

290 . Autumn is, so to speak, the foster-mother for the 
disorders left by the summer-time. Autumn is more healthy 
if the weather be very damp and rainy, and is more unhealthy 
if the weather be dry. 

291. Relation to Periods of life. — The first part of autumn 
is to some extent beneficial for old people, but the last part 
is very injurious for them. (In the first place there is the cold, 
in the second place there is the residue of the oxidation of 
humours of summer-time). 

Changes which Winter produces in the Body. 

292. Winter is a help for digestion, because the cold 
weather as it were embraces the innate heat and fosters it, and 
makes it more concentrated and less prone to dispersion. 

That is why fruits are scarce, and why people feel the need 



4-t 



4.4. 



1-1 



4-0 



192 THE CANON OF MEDICINE 

only of light aliments, and take little exercise after a good meal, 
and gather together in warm places. 

293. In winter there is much sediment in the urine, as 
compared with the summer, and the amount passed is greater. 
The bilious humour is lessened in winter because it is cold, and 
the day is short and the nights long. The insoluble portions of 
the humours are more confined. During the winter, therefore, 
the diet should include more incisive and more attenuant aliments. 

294. The disorders of wintertime. These are chiefly 
phlegmatic in character. The serous humour is _ plentiful at 
this period. Thus, it is very often present in vomited matter ; 
inflammatory foci are usually of a whitish colour in winter- 
time ; coryza is common, and begins when the autumnal air 
is changing. Less common are : pleurisy, pulmonary ^inflam- 
mations, hoarseness and sore throat. Less common still are : 
pains in the chest, side, back and loins ; nervous disorders 
(chronic headache); especially apoplexy; epileptic seizures). 
In all these cases the serous humours are aggregated and con- 
fined, besides being increased in amount. 

295. Relation to Periods of Life. — Winter is inimical to 
old persons and to those akin to them in nature.* Middle- 
aged persons are likely to be in health in this season. 

§ 1:83. The following curves showing the seasonal variations 

in the character of the blood (red cell content ; haemoglobin) as 
made out by modern investigations, are of interest in connection with 
the above (280-295). 




M Cells 




1 1 1 * • \ 1 ; ! ' — 

Jan. Fck. PU. Ap. My J u »i T.I, fl-j- Stf. Oil-. «>*. i«. 

A 

A. Curve showing the variations in red cell count in the same person through- 
out the year. 1-12, the successive months of the year ; 3.9-4-8- number of million red 
cells per c.mm. 

B. Curve showing the variations in hasmoglobin content from month to month. 
! — 12, as in A : 78 — 88, percentage of hasmoglobin. (From Lippincott, Journ. 
Lab. Clin. Med., 1927, 679.) 

* Note that in winter the ground temperature is lowest — 41 deg. F. at end of 
February. 



THE CANON OF MEDICINE 193 

7. The Influences of Seasonal Sequences 
(Seasonal Cycles) 

296. When a northerly spring follows a southerly winter, 
the summer will be very hot, and waters will accumulate, various, 
matters being carried on from the spring into the summer. 
Hence in the following autumn, there will be an increased 
death-rate among adolescents ; and dysentery and intestinal 
ulcers and tertian fever will be frequent. 

297. If the winter was extremely rainy, those due to 
give birth in the spring will be liable, to abort, but if they carry 
to full time, the offspring will be weakly, or suffer from a fatal 
or dangerous illness. Men are liable to eye diseases and 
haemorrhages. Old persons are liable to catarrhs which pass 
down into the interior organs ; indeed they may meet with 
sudden death from a sudden obstruction to the flow of the breath' 
through channels which have become overfull. 

298. If the spring is rainy and southerly, following upon 
a northerly winter, there will be many cases of acute fever in 
the summer, and there will be eye affections, nose-bleeding, 
looseness of the bowels. Most of these depend on the flow 
of serous humour — imprisoned during the winter — passing 
down into the interior organs and then caused to move on by 
the heat. This is specially so in persons of moist tempera- 
ment, like women. Sepsis and septic fevers are also common. 

299. Should the summer become rainy at the time of 
the rising of the dogstar, followed by northerly wind, there is 
a prospect of good health and of the resolution of illnesses. 
Such a season is worse for women and for juveniles, for if they 
escape these illnesses, they run the risk of being afflicted with 
quartan, because the humours become oxidised, and a sediment 
or ash results, upon which dropsy, pains in the spleen, and weak- 
ness of the liver supervene. Such risk is only slight in old per- 
sons or in persons susceptible to cold. 

300. If the autumn after a dry and northerly summer 
is rainy and southerly, it disposes people to suffer from head- 
ache, cough, sore throat,' and coryza in the winter. 

If the autumn after a dry and southerly summer be rainy . 
and northerly, there will be many cases of headache, rheumatism, 
coughs, sore throat, in the winter. 

If the autumn after a southerly summer be northerly, 
the prevailing diseases are those of " expression " (see 286) ' 
and of congestion of humours, as already stated. 

o 



i 94 THE CANON OF MEDICINE 

301 . If both autumn and summer were southerly and 
wet, humours will multiply so that the diseases of expression 
will appear in winter which we have enumerated (294), and it 
will not be long before the disease-matter becomes coherent, 
aggregated^ and imprisoned ; for not only are the humours 
plentiful but there are no vapours to expedite them away from 
the body. This produces a risk of septic diseases. The winter 
will not fail to bring out many disorders because of this very 
cohesion of the undue amount of morbific matter. 

If both autumn and summer are dry and northerly, the 
winter will be beneficial to a person for whom moisture is 
injurious, and also to women. Such persons will, however, 
be liable to dry eye-affections, prolonged catarrhs, acute fevers, 
and mental disorders with depression. 

302. A cold and rainy winter produces burning of the 

urine. 

303 . A very hot and dry summer produces the following 
disorders in the following season : anginas (pernicious, and non- 
malignant) ; anginas which produce a discharge (these may- 
burst externally or internally), anginas which do not produce a 
discharge ; variola ; morbilli (both these last two are favourable) ; 
eye-affections ; mental depression ; difficult micturition ; reten- 
tion of the menses ; retention of the expectoration ; haemoptysis. 

304. If a .dry spring follows a dry winter, this is bad. 
The trees and herbage are liable to decay and they are injurious 
to the animals which feed on them ; and, in turn, to the human 
beings which feed on them. 

§ 1 84. A bnormal quality of the seasons. This idea is developed 
in an interesting manner in the Chinese Classic "Li Ki " 47 (VI) as 
showing the consequences in terms of weather (storms, floods, 
droughts, hurricanes, etc.), and in regard to the prospects in the 
crops (maturing too soon, maturing too late to yield any produce, 
diseases of crops, or infections by various larvae, or insects), as well as 
the possibility of pestilential outbreaks, or the prevalence of such 
diseases as bronchitis, rheumatism, skin diseases, general ill-health 
(debility). Flourishing of certain objectionable weeds among the 
grain or cereals. 

§ 185. Seasonal cycles have to do with the sequences of develop- 
mentnoted among the very low forms of life in Nature, e.g., the growth 
of various orders of fungus (saprophytic, parasitic, non-pathogenic, 
sub-pathogenic, and pathogenic) in various types of soil, or landscape, 
depends on the existence of cold, cold and wet, warmth, warmth and 
wet, warmth and dryness, as they are traced through their various 
cycles (basidium, with basiodiospores, mycelium with gametes, and 
- secidiospores, uredospores and teleutospores). The cyclical changes 



THE CANON OF MEDICINE 195 

which result in the apparent transformation of one " specific " 
micro-organism into another " specific " schizomycete require 
investigation in the open field of Nature. Bacteriology may be said 
to have been imprisoned in the doctrine of immutability of species, 
which is only upheld within the limitations of artificial culture-media 
and inoculation experiments in warm-blooded animals. Many of the 
types so familiar in human bacteriology may be looked on as terminal 
phases of cycles, capable of being maintained at the same rank for 
almost indefinite periods. The remaining nine-tenths of the cycle are 
unknown, from inability to cause the types to re-enter it artificially. 

(f) incidental mutations 
8. Climate 

305. We now proceed to complete the discourse about 
the other changes in the quality of the atmosphere, not preter- 
natural and yet not natural. That is, changes dependent on the 
celestial factors as well as on terrestrial ones. 

306. Celestial factors. — The changes dependent on celes- 
tial bodies, such as the stars, are thus :— if many luminous 
stars rise in one region of the sky, and the sun approaches 
towards that region, the people living directly or nearly directly 
under the sun's rays are exposed to greater heat. But if the 
rays are oblique, the heating effect is lessened. The effect 
of a vertical position of the rays on the head is not nearly so 
great, unless they continue vertical for some time, and are 
direct. (Joannitius says : the rising and setting of the stars 
alters the nature of the atmosphere because when the sun ap- 
proaches them or they it, the air becomes hotter. Under 
contrary conditions, the air becomes colder). 

§ 186. Solar, planetary and stellar influences on man, and 
their relation to disease.— The subject may be summarized as follows. 
{A) Genuine influences. —(a) Solar. Modern observations (Abbe 
Moreux), voiced by H. W. Newton (Quart. Journ. Royal Meteorolog. 
Soc, 1928), show that the existence of planetary influences on 
this earth is only ridiculed by the ignorant. The observation 
of sun-spots shows that there is a relation to the character of the 
weather in certain regions, a relation to the development of earth- 
quakes, and also a relation to mental states. This authority 
traces an eleven-year cycle of change both in the earth's magnetic 
changes and in the sun-spot cycle. The sun-spots are described 
as tornadoes of white hot gas, and affect both ultra-violet ray 
activity and electric radiations. He also suggests that there may 
be another cause concerned which controls both solar storms and 
terrestrial magnetic storms. 



i 9 6 THE CANON OF MEDICINE 

(The relation may be made more tangible by suggesting that 
after all there are actual flames of fire emerging from the sun and 
extending in a tenuous and yet real form right across space into our 
own atmosphere, with inevitable effects both in inorganic and 
organized worlds. Hence to suggest a relation between sickness, 
suicide, and crime and solar storms or even planetary disturbances- 
is not new and cannot be lightly set aside). . 

(b) Solar and lunar. Everyday experience shows that_ the 
atmospheric conditions vary according to the time of day and night. 
The bearing of this on health has therefore been seen from the 
earliest times (Ayurveda, 1924, Aug. ; p. 53)- (c) Planetary rise 
and setting, lunar phases, positions of stars and constellations 
(Arcturus, Pleiades, etc.) are all data for the study of the progress oi 
the seasons. Hence two kinds of cycles come to notice— the cycle 
of climatic changes, with an apparent relation to health and disease, 
both in cattle and in man ; (ii) the cycle of extra-terrestrial changes. 
Naturally the observers of ancient times, who were so convinced ot the 
unity of the visible universe, sought to reduce to rule certain coinci- 
dences in these cycles. Even if their association is irregular or only 
discernible from generation to generation the subject would invite 
study. Even nowadays it is unsafe to decide that there is nothing at 

all to study in it. . 

^87 (B) Fictitious relations. — {a) Symbolical, permissible, 

but superfluous, (i) Stars may be spoken of as " healthy ' or 
" unhealthy," " propitious " or " unpropitious ' (Cantica, 1. 104 ; 
Costaeus Annotations to Avicenna), as a convenient abbreviation tor 
a more or less complex group of concomitant climatic conditions, 
(ii) The names of planets, or constellations may be used to represent 
certain types of mental constitution (Modern astrology) lhus, 
combativeness (fiery temper), ambition and pride, love and desire, 
melancholy, dreaminess, intelligence and wisdom. These are seven 
types assigned to as many planets. Again, the term astral may 
be claimed appropriate because common to the stars and the 
" astral form " of man. The same idea occurs in Paracelsus 
(Hermetic writings, ii. 291), where he speaks of the senses and 
intelligence and wisdom of the offspring being its sidereal body, 
and derived " from the stars." Such usage of names implies that 
there is some specially " deep " learning being propounded which is 
denied to the ordinary student, who has not been initiated into the 
inner circle of some cult— hermetic, rosicrucian, theosophicai, and 
the like The fact is, however, that the phenomena of the so- 
called " astral plane " are those of the " sensitive life " of scholastic 
psychology ; careful and thorough study of this will show that the 
other obscurities are superfluous, (b) Fallacious.— Those who take 
the symbology of (ii) to be literally correct are " of the erring people 
(O 6 78) The poet voiced this error in his words : " A moon which 
Wights you if you dare behold " (Night 34, annotated by Burton, m 

*' 3I But in these days it is easier to fall into the error of supposing 
that there is no relation whatever between this world and sun, moon, 



THE CANON OF MEDICINE 197 

and stars, than to mistake purely terrestrial relations for the trans- 
cendent. 

307. Terrestrial factors, {a) Latitude ; (b) Altitude. — 
High or low ; {c) Mountainous regions ; (d) Maritime countries ; 
(e) Exposure to winds ; . (J) Nature of soil. 

{a) Influence of latitude on Climate. — If the country 
in question be between the Tropic of Cancer and that of Capri- 
corn, the summer will be hotter than in a country further from 
the torrid zone. The countries within the equinoctial zone ap- 
proach equipoise, for while the vertical incidence of the sun's 
rays does not make much impression, the fact of this position 
being maintained for several hours enhances their effect. The 
heat is greater at the middle of the eighth hour (the evening) 
than at noon. Consequently, when the sun is at the end of 
Cancer, or in the beginning of Leo, it is hotter than it is at the 
end of its course. When the sun passes from the tropic of 
Cancer to a place of less declination, its heat is greater than when 
it has not yet reached the tropic of Cancer but is at the same 
declination. In the countries in the equinoctial zone, the sun 
is only vertical for a few days, and beyond that becomes rapidly 
oblique. For the declination increases much more rapidly 
towards the two poles than it does in the tropics. Yet, in the 
tropics, there is hardly any movement perceptible to the senses 
during any three or four days, so long does the sun linger ; 
and all that time the heat is continuous. Hence one may con- 
sider that countries whose latitude approaches complete declina- 
tion are hotter than all others, and next to these countries 
lying within fifteen degrees on either side towards the two poles. 
In the equinoctial line the heat is not so very excessive as it is 
in those countries which, are within the tropic of Cancer, and 
countries which are still further north are still colder. 

This concludes what must be discussed in regard to the 
latitudes of countries, supposing them to be alike in all other 
respects. 

(b) Influence of the altitude of a country ^ whether high or low. — ■ 
Lowlands are hotter, highlands are colder. The strata of air 
nearer to the earth round here, where we live (Persia) are hotter 
because the sun's rays are more powerful ; the rays are more 
oblique on the highlands, which are therefore colder. This is 
explained in the work on natural philosophy. Low-lying places 
take up more heat, and are therefore hotter. 

(c) Influence of mountains on the climate of neighbouring 



198 THE CANON OF MEDICINE 

country. — The climate of mountainous countries from the point 
of view of residence, is discussed in 325. 

High mountains influence the climate in. two ways : (i) 
they reduce the power of the solar rays on the country, and afford 
protection from them ; (ii) they serve as a wind-screen. The 
former holds good when the mountains are on the northerly 
aspect of those countries which are in the north. As the sun 
runs its course across such a northerly country its heat is re- 
flected from the mountains, and so the country is warmed in 
spite of its being in the north. The same applies when the 
mountains are in the west, leaving, the country exposed on the 
east. If the mountains are in the east, the heat which the 
country receives is less than when they are in the west, because as 
the sun rises, hour by hour passes before its direct rays reach the 
country, and by the time they fall vertically upon it, the sun is 
already about to wane, and the heating quality of its rays de- 
clines (J>). When the mountains are on the west, however, 
the rays are more vertical with every hour. 

(ii) Windscreens. — A northerly cooling wind may be 
screened from a country by a mountain-range, in which case a 
southerly warming wind gains the advantage. If a country- 
lies between two mountain peaks the force of the winds across it 
will- be much greater than if it were entirely flat. For when 
air enters a narrow channel it usually goes on blowing without 
ever stopping, just as water and the like would. Natural 
science furnishes the explanation of this. 

Countries whose climate is rendered mild by mountains are 
exposed to some winds, and protected from others. If exposed 
on the east and north, they are protected on the west and south. 
(d) The influence of the sea on maritime countries. The 
atmosphere in such countries is always more humid. If the 
sea is on the north side of the country, that will help to make 
the country cool, for the prevailing north wind is cold in character, 
having come over the face of the water. If the sea is on the 
south side of the country, a heavy southerly climate prevails, 
especially if a mountain range intervenes between the sea and 
the country. 

If the sea is on the east side, the climate will be more 
humid than when it is on the west side, because the sun will not, 
cease increasing the evaporation of water as it rises in the heavens, 
whereas this would not be the case if the sea were on the west. 
To sum up, proximity of the sea makes the climate of a 
country damp, and if there are no mountains to prevent constant 



THE CANON OF MEDICINE 199 

winds, the air is less liable to undergo putrefactive change. 
Were there no winds (because. of an intervening mountain-range) 
the air would be liable to undergo putrescence (of the organic 
matters suspended in it), and the humours of the inhabitants 
would also tend to undergo putrescence. 

Hence it is clear that it is better for the prevailing wind 
to be northerly • it is next best if the wind is easterly ; then 
westerly, and it is worst if the prevailing wind is southerly. 

(e) The influence of winds, (i) On all countries in general. 
In most countries a southerly wind is hot and moist. It is hot 
because of the sun's rays, and it is moist because usually the sea 
is to the south, and the strong heat of the sun on the equatorial 
seas disseminates water vapours which become carried on by 
the winds. This is why southerly winds are relaxing. 

The northerly winds are usually cold because they have 
traversed mountains and snow-clad territories ; they are also 
dry because very little water-vapour is admixed. This is because 
there is very little evaporation of water on the north, and there 
are no seas intervening. On the contrary, they usually traverse 
frozen waters and desert places. 

Easterly winds are between cold and hot in character ; 
they are drier than westerly winds, because there is less sea in 
the north-east than in the north-west, and we live in the north. 

Westerly winds are moist in quality because they traverse 
seas and the sun, passing over the seas, 'warms them and evap- 
orates the water ; but since the movements of the sun and the 
winds are in contrary directions, the evaporation is not as great 
as it is in the case of the easterly winds. Added to this is the 
fact that easterly winds are strongest at the beginning of the day, 
and the westerly winds blow strongest at the close of the day. 
That is why the westerly winds are not as hot as the easterly, 
and more inclined to be cold. The easterly winds are hotter, 
and yet, comparing both east and west with the south and north 
winds, they are temperate. 

Sometimes the character of winds varies in a given territory 
as a result of other factors. It is sometimes an advantage, in 
some countries, for the south winds to be cooler, as happens when 
there is a snowclad mountain range on the south ; these winds 
are cooled in passing over the mountains. When a country 
is enclosed in burning deserts, the northerly winds are hotter 
than the south winds. 

The simooms* are of two varieties: (i) those which have 

* Simoom, " the poison wind," from Samn, poison, venom. (Burton, iv. 36.) 



2oo THE CANON OF MEDICINE 

traversed very hot deserts ; (ii) winds like a sort of smoke, 
producing strange " terrifying " atmospheric effects simulating 
flames of fire. They are heavy and sultry. A sort of kindling 
and combustion occurs in them whereby the light part is separ- 
ated and the heavy part (in which the burning fieriness remains) 
sinks down to the lower strata. All these are powerful winds. 
That is why wise philosophers believe them to arise in the upper 
parts of the atmosphere, although the material basis is from 
below.* But the movement, the blowing and whirling, begins 
in the upper regions of the atmosphere. This is the usual 
explanation, and its proof is to be. found in my book on natural 

philosophy. 

(it) The special climatic characters of the several countries. 
This subject is deferred to a later chapter (318). 

(/) The soil.-f Countries present varied characters accord- 
ing to the dominant kind of soil The following varieties of soil 
may be enumerated : clay, chalk, sandy (humus), rocky, or 
stony, miry or slimy, muddy, evil-smelling. The characters 
vary according to the mineral content. 

Each kind of soil has its own effect both on the atmosphere 
and on the water. 

This statement contains an important truth. Certain spas and health- 
resorts (Carlsbad, Bath, Droitwich, Baden, Bourbonne-les-Bams, Is ancy Wiesbaden) 
owe their virtue not merely to the chemical composition of the water which is taken 
by the patients, but also to the locality itself. The radiations which pass outwards 
„at those parts of the earth produce a beneficent influence upon them as they walk 
over the ground. 

8 1 88 The soil mav be described as the breakdown products of 
rocks or rock-formations of various kinds. Different kinds of soil 
differ in the size of their particles : coarse sands show particles from 
o 1-0.2 mm. in diameter; fine sands 0.5-0.05 mm.; silts have 
particles varying from 0.04 to 0.004 mm. in diam. A sod composed 
of the four groups (sand, clay, chalk, humus) is called " loam if 
good for crops, and is then specified as clay loam, or sand loam, 
according to the dominance of clay and sand respectively. _ It is the 
size of the particles which determines the movements or circulation 
of air and water through the soil. The amount of humus determines 
the fertility in regard to micro-organisms, whether beneficial to 
vegetation, or whether pathogenic to man. The presence of 4 
per cent, of moisture in soil is the optimum for processes of decom- 
position in it. Cold wet soils favour diphtheritic infection (Lane- 

Notter). ^ r , ,,. , ^ ., 

Gravel soil is sought after as favourable for dwellings ; but it 

* The lower strata are near " earth," and the' highest strata of this world 

^t 'ThfsoilmUbll described as elementary substance with which are intermingled 
the decaying remains of animal and vegetable matter. 



THE CANON OF MEDICINE 201 

it be befouled by polluted waters, micro-organisms then flourish more 
easily than in other soils, and it becomes more inimical to health. 

§ 189. The inorganic elements in plants are really very finely powdered stones 
(limestone, iron-stone, magnesium-stone, potash-stone, etc.), which have entered 
into a condition of food-substance under the influence of light and heat, and life — ■ 
(Gilbert.) 

(g) Misty districts and marshes. Joannitius refers to these, 
saying that where there is decomposition in such regions, 
-diseases and various plagues befall man. 

§ 190. The factors on which the climate of a place depends, in 
modern thought, are as follows: (1) the earth heat : the range in this 
is 41-63 F. in England. When hot, the earth reflects ultra-violet 
rays (2) the radiant energy of the sun. " Sun-power," which is 
reflected from the sky and sea and earth. The rays are classified as 
visible, ultra-violet (actinic or chemical), and infra-red. The ultra- 
violet rays are arrested by smoke, mists, window-glass. (3) The 
cooling power of the air. This depends on the rate of movement of 
the air, as currents artificially induced, or wind ; the amount of 
humidity ; the actual temperature of the air. Cold air tries the heart 
and chest, more heat having to be produced ; hot air tries the diges- 
tive organs and kidneys, because of the difficulty of getting rid of the 
superfluous heat. (4) Altitude. The air is thin or rare at high 
altitudes. (5) Ventilation of the dwelling-house. 

To these must be added : prevalent winds ; proximity to sea ; 
scenery ; nature of the ground — whether rocky (cold and dry), 
fertile (hot and moist), muddy (cold and moist) ; whether porous or 
impermeable ; water-holding or not ; actual chemical composition. 

(c) impressions produced by other changes in the 

atmosphere 

9. The Effect of Unfavourable Changes in the Air 

which are Contrary to its Ordinary 
Nature 

IR (308) may be changed in (1) substance, 
(2) qualities. — The substance may become 
depraved apart from any increase or de- 
crease in some of the intrinsic qualities. 
Such an air is named " pestilential."* One 
must remember that putrefactive processes 
can occur in the atmosphere just as they 
do in stagnant water. 

* Though we now know that " pestilential " air is so because it is germ-laden, 
that does not render this chapter " out of date." The general principles remain 
the same. At the present day it is assumed that the air is always contaminated 
from without — from the dust, e.g., on the ground that sunlight destroys germ- 
life. However, facts speak otherwise in open Nature. 




202 THE CANON OF MEDICINE 

309. By the 'word " air " we do not mean the simple {impon- 
derable) element, but the .atmosphere around us. Were the 
atmosphere absolutely pure, the word " air " might be used 
synonymously. But elemental substances cannot putresce ; 
they can only change from one to another (as " water " which 
changes to " air," e.g.), and they do this by a change either in 
quality or in substance. The word " air " in this chapter, therefore, 
as " atmosphere," is a composite substance, with spatial relations, 
composed of true (elemental) air, watery vapour, terrene particles 
(both of which form fogs and clouds, and smoke), and fiery 
particles — all together. In the same zvay, when we speak of 
" sea " as " water," " lakes " as " water," and so on, we do not 
mean elemental water, but a composite substance, in which 
" water," though predominant, is mixed with air, earth, and fire. 

This carries the reader back to 19-25, and the comments thereon. The writ- 
ings of the Chinese philosophers on the one hand, and of European alchemists on the 
other may be interpreted accordingly, as Avicenna would have done. Examples 
of " earth " : soil, metals, naked creatures ; " water " : spring water, ram water, 
ditch-water, lake water ; the sea ; millet ; shellfish ; " fire " : wood, oil, stones, 
lightning, the glow-worm, will-o'-the-wisp, trees, flowers, beans, feathered creatures. 
Seemingly there is very little in common; Forke- 3 (p. 275, 276) discusses the 
subject, at the same time referring to writings by Agrippa von Nettesheim. 

310., The air so present in water may undergo putrescence, 
with degradation of its substance, just as the stagnant water in 
pools decomposes, with degradation of its substance. 

311, Air generally becomes pestilential from putrefactive 
changes towards the end of summer and during autumn. _ The 
symptoms which such air produces in the human body will be 
referred to later. 

312, Change in primary qualities. Heat or cold may become 
insupportable by destroying the crops and the fecundity oi 
nature. This change may be in the same direction as the quality 
of the season (for instance, the summer may become fiercely hot), 
or it may be in the contrary direction (for instance, a spell of very 
cold weather may arise during the summer season). 

313, Effect on the human body. Changes in the character 
of the atmosphere produce changes in the human body. 
Putrescence of air induces septic changes in the body-fluids, 
beginning with the pericardial fluid, because this is exposed to 
it first. . . 

Hot atmosphere. Great heat in the air renders the joints 
flaccid and causes the humours to disperse. There is increase 
of thirst, dispersion of the breath, failing vigour and digestion, 
all because the innate heat is the instrument used by the vegetative 



'"\^W — ' 



THE CANON OF MEDICINE 2 o 3 

soul. A citron-yellow appears in the skin because the sanguineous 
humour becomes dissipated and loses its red colour, while at 
the same time the bilious humour increases in amount relatively 
to the other humours. The heart becomes warmer (over and 
above the innate heat), so that the humours flow and undergo 
decomposition, and in that state they enter the interspaces of 
the body and the weaker members. This is therefore not 
beneficial to persons in health. The following diseases are 
(however) benefited by this change : dropsy, palsy, cold catarrhs 
tetanus, and certain (humid) spasmodic conditions. ' 

Cold atmosphere. This drives the innate heat into the 
interior organs, unless the air has sufficient driving force itself 
to penetrate them. This would be morbific. Cold atmosphere 
does not interfere much with the circulation of the humours 
or imprison them. But it favours catarrh, and is weakening to 
the nerves. It has a very injurious effect on the trachea. If the 
atmosphere is not so cold, it strengthens the digestion and all 
the interior functions, and improves the appetite. On the one 
hand it is more beneficial to a healthy person than a very hot 
atmosphere, and on the other hand it is detrimental to nerve- 
function. It closes the pores and causes matters within the bones 
to pass outwards to the surface. 

Moist atmosphere. A moist atmosphere benefits many tem- 
peraments. It improves the colour and makes the skin clear 
and soft. The pores remain open. However, it favours septic 
processes. r 

Dry atmosphere. A dry atmosphere has contrary effects. 

A dry climate, with warm soil, where the sun power is good and 
the cooling power is moderate (e.g. places with pine forests and 
sheltered valleys) is beneficial for chest cases.— Dry uplands in 
places where there are not periods of unsettled weather, and not near 
the sea, are beneficial for rheumatic cases. 123 

Choice of food according to climate. — For hot climates • no 
meat ; use vegetable oils instead of animal fats. For cold climates- 
meat, animal fats. For dry climates : fruits are needed. For wet 
climates : sugar is needed. 123 (p. 1076). 

Note that the weather affects animals as well as man. Cold hot 
damp, dry weather, thunderstorms, affect domestic animals ^ 
(11. 307.) 

10. The Influence of the Winds on the Body 

In dealing with the changes in the atmosphere, we have 
discussed the characters of the various winds. We now proceed 
to deal with them from another point of view. 



2o 4 THE CANON OF MEDICINE 

314. The North Wind braces and hardens the body ; it 
prevents the flow of visible excretions ; k closes the pores, 
strengthens the digestion, causes constipation, increases the 
urine, and makes septic pestilential atmosphere healthy. If 
the south wind precedes the north, the south wind excites mucous 
discharges, but the following north wind drives these fluids 
inwardly. A discharge may appear externally. Hence a catarrh 
[-al exudation] may become abundant, and chest troubles are 

common. 

Diseases liable to occur when the north wind prevails : 
neuritic pains, pains in the side of the chest, in the joints, in the 
bladder and uterus ; difficult micturition ; racking cough ; 
shivering attacks. 

315. The South Wind is relaxing for the strength ; it 
opens the pores ; makes the humours agitated and confused, 
so that they move from within outwards ; the senses become 
heavy ; it induces sleepiness. It is one of the causes of breaking 
down of ulcers, and makes them itch. It causes diseases to 
relapse, and debilitates. It produces itching in podagra. It 
excites migraine attacks. It causes fevers to become septic. 
It does not, however, induce sore throat. 

316. The East Wind. — If east winds prevail towards 
. the end of the night, and in the early part of the day, they will 
. have already been modified by the sun, being made more rarefied 

and less humid. They are, therefore, drier and lighter in nature. 
But if they occur at the close of the day, and at the beginning 
of the night, the reverse is the case. On the whole, east winds 
are more beneficial to health than are westerly ones. 

317. The West Wind. — If west winds prevail at the end 
of the night and in the early part of the day, the atmosphere will 
not have received the heat of the sun, and is therefore denser 
and more heavy. If they occur at the end of the day and at the 
beginning of the night, the reverse holds good. 

1 1. The Influence of Places of Residence on the Human 

Body 

In a previous section we have considered the characters 
of certain inhabited regions. We now consider _ them from 
another point of view, in more detail, without troubling to avoid 
some repetitions. 

318. Characters upon which the effect of habitable regions 
on -people depends. 

i. Whether high or low-lying. 



T 



THE CANON OF MEDICINE 205 

2. Type of adjoining country (mountainous, maritime, 
open or sheltered). 

3. State of soil (clayey, muddy, mineral, damp, marshy). 
_ 4. Whether the water is plentiful or scarce, stagnant or 

flowing. 

5. ■ Local factors (trees, mines, cemeteries, dead animals, 
putrescent pools). 

6. Purity or impurity of the atmosphere. 

As we have also learnt, the temperament of the air is revealed 
by the latitude of a territory, its elevation or lowness, proximity of 
mountains and seas, the prevailing winds, the kind of soil.. 

In short, whenever the air becomes quickly cold after 
sunset, and quickly warms after sunrise (we know it) is attenu- 
ated. If the opposite is the case, the nature of the atmosphere 
is the contrary. 

The most harmful of all kinds of air is that which con- 
tracts the heart and hinders inspiration, and makes breathing 
difficult. 

We now discuss each kind of locality in turn. 

319. Hot countries. The hair becomes dark or black and 
frizzly, and becomes gathered into tight clumps like pepper- 
flowers ; the digestion is weakened. Old age comes on early, 
owing to the great dissipation of breath, and the draining away 
of the bodily moisture. This is seen in the land of the blacks 
(Ethiopia, Abyssinia). Persons who reside in such countries : 
become aged at thirty, are timid (as the breath is so much dis- 
persed), and the body becomes soft and dark. 

320. Cold countries. Persons who go to live in cold coun- 
tries become robust and stronger, and bolder and more coura- 
geous. The digestion improves. If the climate is also damp 
the people will become obese and fleshy and coarse. The veins 
will not show under the skin of the hands, and the joints are 
indistinct in outline. The body becomes pale and delicate. 

321. Damp wet countries. Here the summer is not very 
warm, nor the winter very cold. People living in humid coun- 
tries have beautiful faces with soft smooth complexions. They 
soon get tired with exercise. They are liable to develop pro- 
tracted fevers, with looseness of the bowels and menorrhage. 
Piles, which are common, often bleed. Septic ulcers, fistulas, and 
aphthous and pustular stomatitis are common ; also epilepsy. 

322. Here the summer is very hot and the winter very 
cold. People who live in dry climates develop a dry tempera- 
ment. The skin becomes dry and dusky as a result of the great 



2.o6 THE CANON OF MEDICINE 

dryness and roughness of the atmosphere. The brain soon 
becomes dry in temperament. 

323. Residence in rocky and exposed places. The climate 
in such places is very hot in summer, and very cold in winter. 
The body becomes hardened and sturdy, very hairy, strong, 
with large prominent joints. Dryness rules in such persons ; 
they are very wide-awake, and resist bad habits, are pertinacious, 
warlike, skilful in the arts, and are energetic in character. 

324. Residence in high altitudes. People residing in high 
altitudes are healthy, strong, and capable of much physical 
work ; they are long-lived. 

High, altitudes are beneficial for nerve cases, but unfavourable for heart cases. 

325. Residence in mountains and snow-clad places. People 
living in such places resemble those living in cold countries, 
being of great stature, strong, fierce, and given to toil, for the 
seasons vary much. These countries are windy, the winds being 
good as long as the snow lasts, but unhealthy when it 
melts, especially if there should be mountains to screen off the 
winds. In this case, the place becomes hot and damp. 

326. Residence in low-lying countries. The air is very damp ; 
and in summer is sultry, without modification by winds. The 
inhabitants are therefore unhealthy and debilitated, liable to be 
depressed and gloomy in disposition. The climate is unfavour- 
able to the functions of the liver. Water is plentiful, and not 
cold, especially if it is stagnant, lagunal or marshy. The air is 
then unhealthy, as you already know. 

327. Residence in maritime regions. .The heat and cold 
of these regions is modified by their moisture ; hence injury is 
resisted, and the body is inreceptive for whatever would otherwise 
invade it. As regards moisture and dryness, no doubt, such 
regions tend to be damp. If the country faces the north and has 
no protection against north winds (the sea being on that side, 
and the country being low), the climate will be more temperate. 
If it faces to the south, the climate will be hot and insalubrious 
(morbific). 

Maritime places are beneficial for nerve cases. 

328. Residence in northerly countries. Persons who live \n 
the north resemble in character those who live in cold countries 
with cold seasons. Diseases of " expression " (288) and those 
due to confinement of the humours in the interior parts are 
liable to occur. Digestion is usually good. Such persons are 
long-lived. 



THE CANON OF MEDICINE 207 

The repletion with, and the lack of dispersion of, the humours 
predisposes to epistaxis and rupture of varicose veins. Ulcers 
readily heal owing to the vigour of the body and the purity of 
the blood ; the external conditions are also favourable to healing, 
because there is nothing to relax or moisten (the tissues). The 
fact that the innate heat is plentiful in such people prevents 
epilepsy from occurring, but if fits should occur they will be 
correspondingly severe, for it would have to be a very powerful 
agent to bring on such fits at all in these regions. 

The great degree of heat in the heart makes such persons 
leonine (wolfish) in disposition. 

Effect on the female sex. Menstruation is defective owing to 
constriction of the channels and the absence of the stimulus to 
menstrual flow and to relaxation of the channels. Some assert 
that this makes the women sterile; that their wombs do not open. 
But this is contrary to experience ; at any rate as regards the 
Germans [Turks, Parthians — in other readings]. My opinion 
is that the great amount of innate heat makes up for the absence 
of the stimulus to flow and to dilate the channels. Abortion, 
it is said, is rare amongst women in these climates, and this fact 
further supports the opinion that their vitality is great. However, 
parturition is not easy because the organs in question remain 
hard and will not open easily. If abortion should occur, it must 
be ascribed to the cold. The milk will be scanty and thick, 
because the cold prevents the blood from flowing easily enough 
to the breasts. 

When the vitality is impaired, people in these regions 
(especially parient women) are liable to develop puerperal 
tetanus, and wasting diseases, because the difficult labour makes 
them strain so much, and consequently risk tearing the veins 
in the chest, and the nerve and muscle-fibres. The former 
leads to pulmonary ulcers; and the latter to spasmodic affections. 
Another effect of the excessive straining during parturition is 
ventral hernia. 

. As regards the age of puberty (in these countries) : hydro- 
cele arises, but disappears as the persons grow older. Female 
slaves are liable to develop ascites and hydro-uterus ; but these 
also pass away as they grow old. Ophthalmia is rare, but is 
severe when it does occur. 

329 . Residence in southerly countries. The climatic features 
in these cases are those of hot countries and climates. The pre- 
vailing winds are not beneficial to health. 

The waters are usually salty and sulphur-containing-. 



20<: 



THE CANON OF MEDICINE 



Moist humours accumulate in the head in people living in these 
regions, as that is an effect of the south ; they pass downwards 
and render the intestines loose. The limbs are weak and 
flabby ; the senses are dulled ; the appetite for food and drink 
is enfeebled ; and the lack of heat and weakness of the stomach 
accounts, for the fact that wine is readily intoxicant. Ulcers heal 
and soften slowly. " . 

Effect on the female sex : Menstruation is profuse and is 
arrested with difficulty. Pregnancy is rare. Abortion is fre- 
quent, simply because illness is so frequent. 

Effect on the male sex : There is a liability to severe diar- 
rhoea ; bleeding of piles ; humid ophthalmia. But these are 
quickly recovered from. Persons over fifty years of age are 
liable to paralysis, which follows on catarrhal conditions. At all 
ages there is a tendency to asthma, spasmodic diseases (tetanic 
spasm, epilepsy), because there is this tendency, for serous 
humour to accumulate in the head. 

Both sexes are liable to develop fever in which heat and cold 
occur simultaneously. Prolonged fevers come on in the winter, 
and are nocturnal. Acute fevers are rare because of the liability 
to diarrhoea, so that the more attenuated part of the humours is 
continuously dispersed. 

330. Residence in easterly countries. When a district is 
exposed to the east, and is sheltered (by trees) on the west, it is 
healthy and the climate is good. This is because the_ sun is 
high over it in the early part of the day, thus rendermgthe 
atmosphere clear. The purified air passes on and gentle winds 
blow over it in advance of the rising sun, their direction being 
corresponding. 

331. Residence in westerly countries. When a district is 
exposed on the west, and is sheltered (by trees) on the east, it does 
not receive the sun till late in the day, when the rays are already 
oblique. Hence the air never becomes rarefied or dry, but re- 
mains dense and humid. The prevailing winds are westerly and 
nocturnal. The climate of such places is therefore as of damp 
countries, and the residents have a moderately hot and heavy 
temperament. The climate is heavy because the air is heavy. 
Were it not for that, the climate would be spring-like in nature. 

Such districts are not as healthy as easterly ones,_ and they 
tend to become more unhealthy. Some say that this kind of 
country is spring-like in its character, and very healthy com- 
pared with other kinds of country. But to my thinking the 
climate has very bad characters, and this is because the sun's rays 



THE CANON OF MEDICINE 209 

do not reach them- until they are no longer strong enough to 
warm the atmosphere ; and then the sun sets at once, and a cold 
night then suddenly sets in. As the air is of humid tempera- 
ment in such countries, the inhabitants are liable to have husky 
voices, especially in autumn ; for they are prone to catarrhs from 
stagnation of the serous humour. 

332. How to choose a place of residence, and what type of 
house should be selected. The choice of a place of residence 
depends on : (1) the soil (see 307f) ; (2) position — whether high 
or low-lying (atmospheric pressure, see 307b) ; (3) whether 
exposed or sheltered, bare or covered with trees or woodlands or 
forests (forests harbour moisture and foster the decay of vegeta- 
tion) ; (4) the water-supply — its quality, whether the water is 
covered in (artificially) or exposed to the air, whether concealed 
or deep, marshy, whether thick or limpid, whether flowing from 
a height or running over stones ; whether salty or " crude '' ;. 
(5) the prevailing winds — whether exposed to or sheltered from, 
the sun ; whether salubrious or not ; fresh (cold) and bracing 
or dry and sultry (having blown over wide tracts of land), or 
moist ; whether cold and healthy ; (6) the neighbouring 
country (maritime, marshy, presence of lakes ; mountainous, or 
flat ; rich in minerals or not ; forests, jungles, etc.) ; (7) whether 
the ground air is pure and healthy, impure and unhealthy, 
making the natives prone to illness ; what sort of illnesses 
prevail ; (8) whether the natives are robust, have a good ap- 
petite and digestion, and are accustomed to food of good 
quality ; (9) the construction of house : whether with large, 
roomy or with narrow entrances ; good ventilation, wide 
chimneys. Do the doors and windows face east and north ? 
One must be specially careful to arrange to have the easterly 
winds able to enter the house and see that the rays of the sun can 
enter all day, because the sun's rays render the air pure. 

One should be close to plenty of sweet running water, open 
to the sky, frozen in winter, and warm in summer, as all this is. 
favourable to health. Nearness to stagnant water and that, to- 
which light has no access is unfavourable. 

(10) Amount of light ; temperature (hot, warm, cold) ;. 
rainfall — average humidity of the atmosphere (see 249). 

§ I9 1 ■ Type of house. The importance of this is well-known, but not as often 
practically attended to. Overcrowding of houses is well-known to be a source of con- 
tinual illness and loss of working capacity, yet only very slowly remedied. It is not 
sufficiently realized that the befouling of the air through lack of air-space between 
the houses is as dangerous as close contact with the organic emanations from the 
human body; Such emanations cling to walls, floors, furniture, fomites, and 
foster the multiplication of infective organisms. The relation between mouldy 
walls and phthisis was insisted by Nash 136 (p. 52). 

P 



2 io THE CANON OF MEDICINE 

We have now discussed the atmosphere and the geo- 
graphical influences sufficiently. We now proceed with the 
corporeal factors. 

(ii). Corporeal Causes unavoidable because 
Physiological. 

12. The Influence of Exercise and Repose. 

8 IQ2 There are three kinds of Movement :— (i) Local ; successive and 
continuous reception of new positions in space ; here belong exercise, gymnastics, 
batmng ° ( 2 ) In quahty : alteration ; this consists in the reception of new qualities ; 
(3) In Quantity (increase or diminution). A certain amount of matter is acquired 
or lost. (Mercier" 2, 517). 

333 . The effect of exercise on the human body varies 
according to (i) its degree (strong, weak) , amount (little, much), 
and according to (ii) the amount of rest taken, (in) the movement 
of the humours associated. 

334. All degrees of exercise (strong, weak, little, or 
alternating with rest) agree in increasing the innate heat. It 
makes little difference whether the exercise be vigorous or weak 
and associated with much rest or not, for it makes the body very 
hot and even if exercise should entail a loss of the innate heat it 
does so only to a small amount. The dissipation of heat is only 
gradual, whereas the amount of heat produced is greater than the 
loss If there be much of both exercise and repose, the effect 
is to cool the body, because the natural heat is now greatly 
dispersed, and consequently the body becomes dry. It the 
exercise entail the handling of certain material, that material 
usually adds to the effect of the exercise, though often there is a 
lessened effect. For instance, if the exercise be in the course 
of performing the fuller's art, there would result an increase or 
coldness and moisture. If the exercise be in the course of the 
performance of the spelter's art, there would be more heat and 

cLrvncss 

335 Repose always has (a) a cooling effect, because (i) the 
envigorating life-giving heat passes away, and (n) the innate heat 
is confined. It has (b) a choking and moistening effect, because 
of the lack of dispersal of waste matters. 

13. Conditions Associated with Sleep and Vigilance. 

336 The effect of sleep is very similar to that produced 
by repose ; that of vigilance is very similar to that produced by 
exercise. In each case we must consider certain properties. 

337 Sleep (i) strengthens all natural junctions (digestion 
of the food and the elaboration of the digestive products into 



THE CANON OF MEDICINE 



21 I 



good blood), by aggregating the interior heat and by relaxing the 
sensitive faculties. (These are in abeyance, in sleep). It does 
so because it renders the channels of the (mind-) breath moist and 
relaxed. (2) It makes the substance of the breath turbid, and 
prevents the exit of the vital breath (so that the vital heat accumu- 
lates in the interior parts). (3) Sleep removes all types of 
lassitude (821) and - it restrains strong evacuations. If then 
followed by appropriate exercise (gymnastics), the power of 
running is increased unless (effete) matters accumulate which 
only the skin can remove. (4) Sleep sometimes helps to expel 
these effete matters, in that it imprisons the interior heat and 
procures the dissemination of the nutrients throughout the 
body, and the expulsion of the effete matters which are under 
the skin, as well as of those which are deep in the interior parts 
of the body. These innermost matters push on those which 
are in front of them in successive waves, until they finally 
reach the subcutaneous tissues and are thence discharged 
from the skin. The same action is achieved by wakefulness 
to a still greater degree, but in this case the effete matter is 
removed by dissipation, whereas sleep removes it by inducing 
sweating. (5) Sleep induces sweating. It does this by a 
process of overcoming the effete matter, and not by a process of 
continuous dispersal of attenuated matter. When a person 
sweats heavily during sleep, without obvious cause, nutrients 
accumulate in excess of the bodily requirements ; when sleep 
encounters matter adapted for digestion and maturation, it turns 
it into the nature of blood and warms it, and in consequence 
innate heat is engendered, and travels through and warms the 
whole body. (6) If there are hot bilious humours, and the 
period of sleep is prolonged, the body grows warm by extraneous 
heat. (7) If at the time of sleep the stomach is empty, the 
sleep will exert a cooling effect, in that it disperses the heat. If at 
the time of sleep there is a humour not amenable to the digestive 
power, the sleep will exert a cooling effect because of that to 
which this humour gives rise. 



Factor associated during the time of 
sleep. 


Effect on body. 


Profuse sweating. 

Gastric contents digestible. 

Hot bilious humour. 
Empty stomach (fasting) 
Indigestible humour. 


Accumulation of nutrients. 
Completion of digestion and blood- 
formation : formation of innate heat. 
Formation of extraneous heat.' 
Cooled ; heat is dispersed. 
Cooled ; expansion of heat. 



212 THE CANON OF MEDICINE 

8 193. Aetius adds: . 

Among the good effects of sleep are : forgetfulness of mental sufferings, rectifi- 
cation of the distracted powers of reason ; relaxation of contracted tissues 

The best time for sleep is after a meal ; it should end when the food is digested 
(shown by percussion over the stomach), after which the bowels should be emptied. 

The best time for sleep during the 24 hours is the night, because the humidity 
and drowsy stillness of night contribute to perfect digestion. The worst time is 
the day-time, because in that case one does not sleep long enough to enable the di- 
gestion of the food to be completed. The result is acidity, flatulence, gurgling 
in the bowels. 

338. The waking state acts in the contrary way in all these^ 
respects. If it occur to an excessive degree, the temperament of 
the brain changes to a certain dryness, with weakening and con- 
fusion of the reasoning power, oxidative changes in the humours 
and acute illnesses resulting. An excessive degree of sleep, on 
the other hand, exerts an opposite effect, for it dulls the powers of 
the mind, induces heaviness of the head and a cold intempera- 
ment. This is owing to the hindrance of resolution which such 
sleep brings about. 

339. The waking state (i) disperses the matter, and so 
increases the appetite and sense of hunger ; (2) disperses the 
digestive power, and so impairs digestion. 

During the waking state the body becomes hot exteriorly, cold and dry 
interiorly (Joannitius). 

Insomnia (lit. tossing about in bed), a state between watch- 
fulness and sleep, is bad for all the bodily states. 

340 . Undue somnolence entails an imprisonment of the 
innate heat, and makes the body become cold exteriorly. This 
is why so many blankets are needed to keep the limbs warm 
during sleep, which are not required in the waking state. 

The indications furnished by somnolence, and its various, 
aspects, and states, will be fully dealt with in subsequent volumes,. 
Allah willing. 

14. The Influence of Perturbations of Mind. 

.341. Changing states of mind (nafs), and the associated 
" motions " of the breath are either interior or exterior, sudden, 
or gradual. 

When there is coldness interiorly, it moves outwards with the 
breath ; hence if the breath were suddenly dispersed, the cold- 
ness becomes excessive, and both exterior and interior cooling 
occur, which may be followed by syncope or even death. 

When there is coldness exteriorly, and heat interiorly, the 
coldness moves inwards with the breath. 

342. Great confinement of the breath, with both exterior 
and interior cooling, results in severe syncope and even death. 



THE CANON OF MEDICINE 



213 



Movement of the breath. 


Direction. 


Associated emotion. 


Sudden and forcible 
•Gentle and gradual 
Sudden and forcible. 
Gentle and gradual. 


Expansibn. 
Contraction 


Outward 
Outward 
Inward. 
Inward. 


Anger. 

Delight and moderate joy. 

Fear, terror. 

Gloom (" contracted 

heart ") mental de 

pression. 



343. Confinement and dispersal of breath only occur 
suddenly ; _ languishing of breath only develops by degrees. 
By " languishing " I mean a slowly progressive confinement or 
coarctation of the breath. When I say "the nature declines,"* 
I refer to a gentle, gradual, step by' step dispersal of the vitality. 

344. If two motions of the mind occur simultaneously, 
the breath may move in two directions (contraction within itself, 
and enlarging) at once. This happens (1) when there is fear, 
dread, and anxiety about the future. (2) when anger and gloom 
occur simultaneously. The two opposite movements may pro- 
duce a sense of shame, because there is first the confinement of 
the breath in the interior parts, and after that the power of 
reason returns, and resolution appears, allowing the contracted 
breath to expand again, and bring heat to the surface. The skin 
now becomes red. 

345. Influence on the body of mental disturbances of a different 
category. The state of the mind of the parents affects the body 
of the offspring ; as for instance, phantasies. As a rule, it is 
some natural object which impresses the body. For instance, 
some image of a boy pictured by both parents at the time of 
conception may be realised in the infant when born ; or the 
infant's breath may have a " colour " very like the colour seen 
(mentally) by the mother whilst the seminal fluid was flowing 
into her at coitus, or by the father during the time of this flow.f 
Many persons hate to believe such things, and suppose they 
can understand the states of the body without having realised the 
fundamental state. The physician who seeks wisdom does not 
deny these and allied things. 

* See footnote to 199 (ii). 

f Superficially, the suggestion that conception is synchronous with coition 
would seem an instance of mediaeval ignorance. Costaeus, in annotating on the 
passage, accepts the opinion that a strong desire on the part of either parent to see 
self or partner repeated and reproduced is capable of securing that the conception shall 
yield a child in whom the desire is ultimately realized. Favourable patency of 
the internal ducts (cervix, etc.), whether anatomically or emotionally, in association 
with voluntary control of supposedly purely involuntary muscular tissue, are co- 
operative factors whereby the above suggestion is not error but sometimes fact. The 
law of jelal and jemal plays an important part which is ultimately, in due time, 
manifested by the sex of the product of conception. Thus when the male is jelal 



2i 4 THE CANON OF MEDICINE 

346. Other, instances of the influence of the phantasy on 
the bodily state : (a) a movement of the mind which is intent on 
considering red things induces a corresponding state of readiness 
for a movement of the sanguineous humour. [Exanthems may 
be associated with such a movement of sanguineous humour 
(Costaeus)]. (b) energetic character : eating acrid things : 
hardening of the -teeth, (c) introspective character : dwelling 
on aches and pains in the limbs : aches and pains in the limbs, 
(d) timid character : fearing lest some imagined event should 
happen : change of temperament corresponding. [Fear of 
catching a certain complaint : actually developing the disease 
(Costaeus)]. (e) hopeful disposition : rejoicing in the thought 
of something one would like to realise : change of temperament 
corresponding. 

DIETETICS 

K, The Influence of Food and Drink. 

" Most illnesses, even those which lead the sufferer to the specialist, arise 
solely from long-continued errors of diet and regimen." 

347. Food and drink influence the body in regard to (a) 
quality; {b) material composition ; {c) " substance " as a whole. 

It is essential to define each of these three terms exactly. 

(a) Influence in regard to quality. — Heating and cooling 
food and drink respectively make the body hot in virtue of 
their own heat ; cold in virtue of their own coldness ; and 
yet these qualities do not become an integral part of the body. 

(F) Influence in regard to material corn-position. — The food 
and drink in this case change from their own nature, so as to 
receive the " form " of one or other of the human members 
(tissues) ; and the matter of which the food is composed receives 
the " form " of the member, without losing its own dominant 
primary quality right through the whole process of digestion 

the product is female, and vice versa, — the jelal or jemal relating not only to physical 
affection, but to "anguish of love " ; and the physiological cycles in the two organisms 
have also to do with the chances of conception. The subject is dealt with more 
particularly in the fourth Book, in a form which is only apparently obsolete. 

The belief that maternal mental states affect the growing embryo, both 
physically and psychically, is natural, though rejected by some physicians. It is 
a valuable saying that " we can control the attributes and thoughts of the offspring 
and give it a far more valuable inheritance thereby than by any material fortune."" 
It applies as an admonition to both parents. 

" The woman produces an offspring like that being upon whom her thoughts 
dwell at the time of conceiving." — (Charaka-Samhita, ii. 704.) 

By contemplating on beautiful scenes of nature, beautiful pictures, pious 
persons, etc., the mother contributes to make her child beautiful and virtuous 
and possessed of other desirable qualities (ib. 745) 

The whole subject bears on the causation of deformities, or malconforma- 
tions (496). 



THE CANON OF MEDICINE 2 i$ 

to the end of assimilation. Thus, the temperament of lettuce is 
colder than that of the human body, and yet lettuce becomes 
blood, and is thus capable of being converted into tissue. The 
temperament of garlic is hotter than that of the human body and 
it also becomes blood. 

_(7) Influence in regard to "substance" as a whole. The 

specific " form."— This is an action according to what food 
is in itself, as apart from its four primary qualities, and apart 
from whether it becomes like the tissues or not, or apart from 
whether the body becomes like to it or not. Matter does not 
enter into action in virtue of its quality of action. But action 
ensues in virtue of its matter when the matter is changed by a 
transforming faculty in the body, from the substance it originally 
possesses, and (i) first renews whatever has been used up in 
the body, and so (2) increases the innate heat in the blood. 
Then (3) the effect of the primary qualities which remain 
in the food after that comes into play. 

.348. Action occurs in virtue of the substance when the 
" form " of its " species " — resulting from its temperament 
(for the elementary components are intermingled, and one 
single thing emerges therefrom) —is made ready for receiving 
the species ; a certain " form " is now super-added over and 
above the _ form possessed by the primary qualities. But this 
" form " is neither (1) the primary qualities of the matter, 
nor (2) the temperament proceeding from those primary qualities. 
This " form " is that perfection which the pattern of the ailment 
receives according to its capacity, and its capacity is the out- 
come of its temperament. Example : the attractive faculty 
of the magnet ; the nature inherent in the various species of 
plants and animals (the nature emerging from the temperament). 
Nor is this " form " (3) any of the simple temperaments by them- 
selves, for it is_ not hotness, moistness, dryness, or coldness, 
either alone or in combination. Really speaking, it is some- 
thing comparable with colour, odour, or intellect, soul, or some 
other " form " imperceptible by the senses. 

349. The " form " which arises after the temperament 
has formed may ^be perfected by passive action. In this case 
the " form " = " passive property." But it may also exhibit 
active perfection. In this case " form " = " active property " 
(active principle). This active property may be exerted upon 
a human being, or it may not. 

350. Any property may produce an effect on the human 
body which is either desirable (useful, harmonious) or undesir- 



2i6 THE CANON OF MEDICINE 

able (inharmonious). Such an effect is not entirely derived 
from its temperament ; it is also derived from the specific 
" form," over and above the temperament. Hence we speak of 
such an effect as derived from the substance as a whole (that is, 
the " specific form "), and not from any of the primary qualities 
or from a temperamental' intermingling of the qualities, .bor 
instance, the action of peony in annulling epileptic seizures is 
desirable. The action of aconite in destroying human sub- 
stance " is an instance of undesirable action. 

* * * 

351. Returning from our digression, then, when we say 
that a substance which is eaten or is introduced hypoder- 
micallv (e.g. by inunction) is "hot" or "cold," we mean 
not only that it is so virtually (not actually), but that it is virtually 
hotter or colder than are our bodies. 

352 " Power" "potentiality" is a term with two kinds 

of meaning, (a) It may be used in reference to the action of the 

' innate heat of the body upon it. As soon as the potentiality 

encounters the action of the innate heat it submits to that, and so 

becomes act. 

(b) The word potentiality may also be considered inreterence 
to its utility or advantage to the body. Thus we say that 
sulphur is hot in potentiality (" virtually hot "). 

353. When we say that a thing is hot or cold, we may mean 
that one of the four imponderables is dominant in its tempera- 
ment ; and we do not refer to the effect which it has on our 

bodies. ■,•■•. u a 

354 We may say that a certain medicine has such ana 
such a potentiality, thereby meaning its utility or otherwise to 
the body. Thus,' a scribe who has stopped writing still has the 
■potentiality for writing. So we say that aconite has a destruc- 
tive potentiality. In the one case, there is no act till after the 
body has become evidently changed. In the other, the action 
occurs at once, from the mere presence of the agent {e.g. viper 
poison), or some time later, after it has undergone some certain 
change in quality (e.g. aconite). _ , 

(c) Between these two potentialities there is a third. — that 
of poisonous medicaments. 



* * * 



355 e There are four orders of medicaments — whether eaten, 
or taken °in the fluid state, or whether given by inunction. 

i„ The first degree. The action of the quality ot a 
medicament on the body is imperceptible to the senses. Thus, 



THE CANON OF MEDICINE 217 

a warming or cooling effect is not perceived by the senses unless 
it is given repeatedly, or in larger dose. 

2. . The second degree. A greater degree of action, without 
perceptibly interfering with the functions of the body or changing 
their natural course (excepting incidentally, or because given in 
large doses). 

3. The third degree. There is evident interference with 
function, but not markedly enough to produce breakdown or 
death of tissue. 

4. The fourth degree. Destruction or death of tissue is 
produced. This is the degree produced by poisons. A poison 
is lethal in all respects (that is, in all parts of its " substance "). 

§ 194- (Another classification would be (a) medicaments which produce 
change without destruction of function or tissue, (6) those which actually destroy 
function or tissue. In each case there are two degrees— one imperceptible to the 
senses, the other plainly evident.— This is Galen's grouping. The grouping into 
four degrees still survives in the classification of burns.) . 

Substances which are definitely poisonous may be classified into four groups 
as follows : ^ 

(i) Corrosives. These produce immediate and violent irritation. Ex • 
mineral acids, alkalis, corrosive sublimate. 

... T/ (-) {quants : (a) Metallic, such as lead, copper, arsenic, phosphorus ; 
(b) Vegetable, such as drastic purgatives (aloes, colocynth, croton oil) ; (c) Animal 
such as canthandes. This group produces effects which simulate natural disease 
such as gastric and intestinal disease, peritonitis, abdominal catastrophe. 

_ (3) Neurotics. Ex. : hydrocyanic acid and the cyanides, opium, strychnine 
aconite, belladonna. 

(4) Gaseous, (a) Irritant : halogens, ammonia ; (6) Anaesthetics ; (c) Coal- 
gas, carbon monoxide, etc. 

There is another group classifiable under 355, 1 and 2, exemplified by common 
salt, whicn is injurious or even toxic in cases of kidney disease ( iai , p. 390) ; and by 
those foods against which some persons have idiosyncrasies, or " protein sensitive- 
ness (shell-fish, fruits, etc.). 

356. Fate of medicaments taken into the body. 

A.— They are changed by the body (passive change). 
(1.) The body itself is not changed nor restored to health 
(a) Medicament changed into the likeness of the body - pure nutriment 

{b) Medicament changed, but not into the likeness 

,.. , ^ of the bod y ------ attempered medicine. 

(11.) The body itself is also changed (active action). 
(a) Change in medicament produces change in body, 
and interferes with or even arrests function. 
(a) the change is into the likeness of the body - medicinal food. 
(ft) not into the likeness of the bodv - - - pure medicine 

(6) The change in the body continues till life is 

destroyed ------ venomous medicine. 

B.— Ihey are not changed at all by the body, but they 
produce a (deleterious) change in the body (active 
action on the body) - pure poison. 

Ad. B. — In saying a medicament is " not changed by our 
body " we do not mean that it does not induce a formation of 
heat in the body by affecting the innate heat, for, as a matter of 
fact, most poisons only act on the body in that way, thereby 



2i8 THE CANON OF MEDICINE 

producing warmth. We mean that its " form " is not changed, 
and that in consequence its, power continues to influence the body 
until the latter has destroyed the " form." For instance, if the 
nature of the medicament be hot, its nature reinforces its pro- 
perty of dispersing the breath. Examples : viper venom ; 
aconite. Again, if the medicament be cold, its nature rein- 
forces its property by congealing or enfeebling the breath. 
Ex. : scorpion venom, hyoscyamus (or, hellebore). 

Ad. A. La. — Anything that is nutritious will eventually 
change the temperament of the body, and in a natural manner. 
It warms the body because when it becomes blood that is the 
natural effect ; and the body becomes warmer. Lettuce and 
gourds warm in this way. So in saying " warm " we do not 
mean " warm the ' form,' ". but " warm that which arises out of 
its own intrinsic quality — the ' species ' remaining." 

Ad. A. ii. a. — Medicaments which are foods are altered by 
the body first in quality, and later in " substance." This change 
in quality may be in respect of heat, so that the medicament 
warms (e.g. garlic) ; or it may be in respect of cold, so that the 
body becomes cold (e.g. lettuce). Afterwards, when the 
digestion and conversion into good blood has been completed, 
the medicament produces warmth to the same extent to which it 
has added to the volume of the blood, thereby increasing the 
" substance " of the innate heat. How could it do otherwise 
than furnish heat when it has itself been made hot, and its cold- 
ness thereby abstracted ? 

But even after the medicament has been changed in sub- 
stance there still remains some of its innate quality (some hot, 
some cold). There is some of the coldness of the lettuce left in 
the blood which has been made from the lettuce, and there is 
some of the heat of the garlic left in the blood which the garlic 
has given rise to. This holds good for a certain period of time. 
357. Some nutrient medicines are medicinal in quality 
rather than nutrient, and others are nutrient rather than medi- 
cinal. Some of the latter are more like the " substance " of 
blood in nature (e.g. wine, egg-yolk, meat-juice), and others are 
less so (e.g. bread, meat) and others are entirely different to the 
substance of the blood (medicinal foods). 

Food changes the state of the body both in quality and 
quantity. Changes in quality have been discussed. 

358_ Changes in quantity are in two directions. Either the 
nutriment increases in the body until there is an aversion to 
food ; obstructions therefore arise, and putrescence results. 



THE CANON OF MEDICINE 



219 



Or it diminishes in amount until the body wastes away, and the 
tissues dry up. 

An increase in amount of nutriment is always cooling in 
effect unless decomposition supervenes in it, so giving rise to 
warmth. This warmth, due to putrescent changes, is extran- 
eous ; for such changes [in the superfluous nutriment] are the 
means by which extraneous heat [as opposed to innate heat] 
enters the body. 

359. Classification of Food-Stuffs. 

(This passage is arranged in tabular form). 



Texture of 
nutriment. 


Nutritious 
quality. 


Name of Aliment. 


Notes. 


Attenuated 
(i.e., produce 


Rich. 


Meat juice, wine. 
Eggs (raw or lightly 

cooked). 
Pottage. 


These are considered rich 
in nutriment because 
most of their substance 
is utilized by the body. 


attenuated 
blood). 


Poor. 


Potherbs. 
Juleb. 

Fruits (matian, pome- 
granates, and the like). 


These are attempered in 
substance and quality. 


Dense 
(i.e., thicken 
the blood). 


Rich. 


Hard-boiled eggs ; veal. 




Poor. 


Cheese, salted meat, 
egg-plant and the like. 


These are considered poor 
in nutriment because 
only a small portion of 
them becomes blood. 



360,, Arranged according to Quality of Chyme. 

1. Making good chyme : egg-yolk, wine ; meat-juice, are highly nutritious : 

they are attenuated. 

Lettuce, matian, and pomegranate are feebly nutritious. These 
are attenuated. 

Boiled eggs, year-old lamb are highly nutritious. These are dense 
m texture. 

2. Making bad chyme: newly-killed meat of sucklings, pheasant, partridge 

lung ; these are highly nutritious, and attenuated. 

Radish, mustard, and many other kitchen-herbs ; these are nutrit- 
ious, and attenuated. 

Veal, duck, horseflesh ; these are highly nutritious, and dense in 
texture. 

Salt meat is feebly nutritious and dense in texture. 

It will be easy to find the foods which occupy an inter- 
mediate position between the attenuated and densely textured 
foods. 

§ 195- _ The study of food should include the following aspects. 

(1) Digestibility. This depends on the density or tenuity of 

texture of the food-stuff, as well as on the materials with which it is 



220 THE CANON OF MEDICINE 

associated. Thus the more fat-content, or fat-addition (from foods 
combined with it), the less digestible, because the less permeable. 
Again, digestibility may : be completely removed by so simple a 
procedure as taking certain liquids (among -them, pure water) at 
an unsuitable time after digestion has begun, or liquids which are 
incompatible with certain foods before digestion, or in a state of 
partial digestion. Avicenna's conception of the gastric contents as a 
"broth" or "emulsion" is legitimate, and if these contents are 
" torn off" the mucosa by foods or fluids taken after the digestion 
of the meal has got under way, the whole process may stop beyond 
power of renewal. The same holds good for the process in the small 
intestine. This idea, ruling in the Canon, can be verified by anyone 
in his daily experience. — Palatability has to do with digestibility. 

(2) Assimilability. This depends on the kind of chyme which 
will result. 

(3) Ntitritive value. This, according to the Canon, will depend 
on the kind of " humour " which the food yields ; how much residue 
it leaves (therefore, whether constipating or relaxing). Thus we 
have the classification of foods, according as they (1) enrich the blood : 
cereals ; dairy produce, such as soft boiled eggs, milk ; fieshmeat ; 
fowl ; certain vegetables. (2) Enrich the serous humour : mutton, 
pork, one-year lamb, the potherbs atriplex and purslane. (3) In- 
crease the amount of bile made, or excite a flow of bile : chicken, 
fish with few scales and agile in habits, the potherbs garlic, mustard, 
nasturtium. (4) Increase the amount of atrabilious humour : 
goatflesh, newly-killed meat, cabbage, lentils. In each class there 
would be subdivision's according to the digestibility— whether 
digestible within two hours, or four hours, or later. 

(4) Physiological value. This is a more general aspect,_in that 
the other aspects contribute to its assessment. The old division of 
foods into proteins, carbohydrates, fats, salts, water is not necessarily 
to be rejected in favour of the modern division of foods according to 
energy-values, heat values, and " accessory factors." Chemical 
analysis of foods suffers from the fallacy that the substances so found 
do not exist as such in the food — a statement based on the same 
principle as will be discussed more carefully under the subject of 
" drugs." Moreover, were these substances present as such, they 
certainly do not circulate in the body, or function in the tissue cells 
in the chemical form found under artificial conditions. Physiological 
values may be assessed according to whether an ash is left in the 
tissues after oxidation or not. Thus, body-building foods leave 
an ash, heat generating foods do not. The important matter is the 
formation of ash, because of the risk of this lingering in the body, or 
even becoming firmly imprisoned in its tissues. Foods may also be 
studied in regard to their depurative properties, according to their 
alkalinity or aciditv, etc. See also 768, 773, 795, and §§ 248-252. 

Thus there are other considerations than the popular ones of 
work-production, and the practical objects which rule properly only 
in the management of domestic animals. 



i6. 



THE CANON OF MEDICINE 221 

The Various Kinds of Drinking Water. 









ri~ J, '4 i 



\k - J %1 



.=> ":■■ -i 
* ■, : r , \ 

' 2. ~ * ' V: 
- ' ■ C- .".I 

-"" .-. < ; ! 

','■1 
.-;. ;- '._1i 



■/. Sr-yj- 



4 









iNote the very great importance which the Moors attached to proper water- 
supply. Having been accustomed to the life of the desert, they appreciated the value 
of water better than any other peoples. 

361. Water is the only one of the elements which has the 
special property of entering into the composition of food and 
drink — not that it is itself nutriment (although it will by itself 
prolong life for some time), but rather that it enables the aliment 
to penetrate into the human body and permeate and purify its 
substance. 

We do not wish to imply that water does not nourish at all, 
but we mean that it is not, as nutriment is, potential blood giving 
rise ultimately to tissue-substance. As an elementary sub- 
stance, it is not changed in state in such a way as to become able 
to receive the " form " of blood or of tissue. This can only 
occur with a true compound. 

362, _ Water is really a " substance " which helps to make 
aliment fluid and attenuated, so that it can flow easily into the 
blood-vessels and out of the excretory channels. Nutrition 
cannot be effected without ic ; it is the handmaid of nutrition. 

There is much to be said as to the part played by water in the 
economy. Though apparently simple, its chemical structure is 



2 22 THE CANON OF MEDICINE 

complex. It is a -mixture of units of varying molecular complexity, 
each unit being called a " hydrone." The number of molecules of 
hydrone and polyhydrones ; constantly vanes, even at steady tempera- 
tures, so that equilibrium regarding them is easily disturbed The 
foreign matter always present in the water of Nature is essential to 
life, assimilation being only possible in virtue of such constituents. 
Apart from this, water is essential to metabolism— absorption, 
digestion (enzyme action depends on it), osmosis, temperature 
regulation, the maintenance of the salt concentration of the blood 
at a constant level. The necessary reservoir of water in the tissues 
is furnished by the muscular tissues, and their depletion has 
serious consequences (502, § 274-279.), and their repletion entails 
important interference with the physiological functions. It may be 
noted however, that the idea that plentiful consumption of water 
" flushes " organisms out of the body is not reliable. (Hemmeter, 
Med. Rec, May 22, 1920.) 

363 The various kinds of water differ (1) not merely in 
the substance of aquosity, ■ but (2) in admixed matters, (3) their 
own individual dominant primary qualities. .111 

364 The best water is that from springs, provided they 
arise in places uncontaminated by extraneous qualities. _ Waters 
from rocky places are only good if they are not admixed with 
earthy matters of putrescible nature which might cause the 
water to putresce. Spring water from thx open ground is 
healthier than water from a rocky place, provided it is flowing. 
But not all flowing water is good ; it must be also exposed to the 
sun and winds. Water acquires nobility from the region 

whence it flows. , 

365 Stagnant water is not as bad in quality when exposed 
to the air'as when it is deep underground. Yet running water is 
not necessarily exposed to the air ; it is only so when it breaks 
out from underground and flows out over the soil. Note, too 
that water running over soil is more wholesome than that which 
runs over stones, because the soil cleanses it by filtering off the 
admixed extraneous matters in a way which stones do not .but 
the soil must be open to the sky ; it must not be fetid or boggy 
or nitrous, or the like, for should a large volume of water flow 
rapidly over such soil, the admixed matters would pass into its 
own nature. If the direction of the flow were eastwards, and 
in summer, it would then be reputed as better m quality, especi- 
ally the further away from its source it is collected. Such water 
readily becomes warm or cold in the body. The next best water 
is that which runs northwards. Such water passes slowly 
through the stomach and is indigestible, and becomes warm or 
cold in the body only slowly. Water which runs westwards or 



THE CANON OF MEDICINE 223 

southwards is bad, especially if the winds are southerly at the 
time. ; . 

366. Water which comes from high regions and has other 
good qualities is more healthy. It is sweet, as it were.. It will 
not bear being mixed with wine except in- small amount, and 
unless the wine is light. It quickly becomes cold and quickly 
warm because its " substance " is attenuated. That is why it is 
cold in winter and warm in summer. It is tasteless and has no 
odour. It passes out rapidly as urine, because whatever there 
is in it which requires digestion is rapidly digested and dispersed. 

367. You must note that the quickest way of assessing the 
quality of a water is by its weight. Light water is healthier in all 
respects. The weight may be ascertained by measure or by 
means of the following procedure. Soak a linen cloth of like 
weight in each of two waters to be tested. Dry thoroughly. 
Weigh. The water belonging to the cloth which is lighter "is 
the more satisfactory. 

The characters of pure water, therefore, are: (i) Aspect: limpid, 32 clear, 
pellucid, " diaphana." 83 (2) Taste: tasteless, or "sweet," 32 pleasant to drink, 
and refreshing. (3) Odour : none. (4) Touch : soft, or gentle 32 ; cool. 33 (5) Other 
properties : weight (367) ; vegetables boil quickly in it ; the place from which it 
is obtained is neither too hot nor too cold ; " fertilizing " and " calm " (Honen 32 , 
P- 6 33) ; passes out of the body quickly (366). 

368. Purification of water. Bad water may be purified by 
sublimation and distillation. If that is not feasible, boiling will 
suffice, for boiled water, as the learned know, is less likely to 
cause inflammation and passes more rapidly through the body. 
Ignorant persons believe that when water is boiled the attenuated 
part is dispersed, and that therefore it is made denser ; hence 
they think it is better not to boil water. But as you know, the 
very nature of " water " means that its particles are alike in 
attenuation and density. It is pure, simple [in the scholastic 
sense], and will not thicken by boiling except in virtue of a cold 
quality being dominant in it, and of earthy particles beino- 
plentiful in it, which, although extremely minute, are not easily 
separated out or precipitated. They are not plentiful enough 
to break the continuity of the water and are too small to separate 
out by standing. Hence they are bound to remain admixed 
with the substance of the water. Boiling removes the density 
which the quality of coldness produced ; the particles of water 
are then forcibly rarefied and the substance of the water becomes 
more and more rare, until the heavy earthy particles hitherto 
suspended burst loose and fall down and sink to the bottom. 
A nearly quite pure water remains behind. 



22 4 THE CANON OF MEDICINE 

369. That which has been separated by the distillation is 
like (or very nearly like) in texture to that which remains behind, 
for the particles of the water which has been distilled off are of the 
same tenuity as the particles of that which remains. The 
process of boiling does not attenuate or rarefy water directly ; 
it does so only because it allows the cold quality to aggregate, 
after which the admixed matter settles out. The proof of this is 
that if a thick water be left to stand for a long time, hardly 
anything settles out of it, but as soon as one boils it there is an 
abundant precipitate and the water becomes light and clear, 
because the boiling has made it rarefied. So, too, have you not 
noticed that the waters of such a big river as the Jihon * especially 
if collected a long way from its source, are very muddy at the 
time but in a short time suddenly clarify by sedimentation, and 
if you pour off the clear water and leave that standing, practically 

nothing settles out of it ? .... „, 

370 Some people praise Nile water very highly. I hey 

enumerate four virtues in it : (i) the length of time which has 

elapsed since it left its source ; (2) the good character of the soil 

of the countries through which it travels ; (3) the fact that it runs 

from due south to due north, so-that a continual rarefaction of its 

waters is taking place ; (4) the incredibly enormous volume of 

the water pouring into it. 

371. If one should pour bad water every day from one 
vessel to another, one would see as much deposit on the last day 
as on the first. There is so little deposit during a day that it 
never clarifies properly. The reason is that the admixed earthy 
particles easily separate out from rarefied matter, for that is free 
of heaviness, viscosity or oiliness, but not so easily from dense 
matter. Boiling increases the rarefaction and so do the shaking- 
movements incident to ebullition. 

Commendable Waters. 

372 Rain water is the best of waters, especially when it 
falls during summer or during a thunderstorm. [Others say the 

* The river Jihon, or Oxus (modern Amu Darya), is one of the great rivers of 
Central Asia It runs through the country of Khorasan, between Samarcand and 
thfcounlry called Bactria, as stated in the Glossary to the Venice edition of the 
Canon Arising in the enormous glaciers of the mountamous_ ranges between East 
Skestan and Afghanistan, and receiving important tributaries from the northern 
slopes of the Hindu Kush, it emerges into open country being here bounded by 
Bokhara on the north. It'varies frSm 1.000 yards to a mile in width in t^s region 
and the stream flows from 7.\ to 5 miles an hour. It empties into the Sea of Aral 
So ereat a ri£r would naturally be prized by the Persians, who regarded it as the 
eaull of the NUe The fact that the great trade route of Central Asia from Khorasan 
to China ioined this river in the above-mentioned region made it well-known to 
Avicer a , 3 Zugh virtullly unknown to Europe until 2 oo years later, when Marco 
Polo and his companions entered this country. 



THE CANON OF MEDICINE 22 $ 

rain which falls in the spring, and that which falls during winter 
are best,_ then that which falls during the fruit season, whereas 
that which falls in summer is worst.] Rain falling during 
stormy weather is very polluted and impure in nature, for at this 
time the violent winds agitate those clouds whence the rain comes. 
373. . Rainwater readily undergoes putrescence in spite of 
being called laudable: This is because if is so rarefied that cor- 
ruptible terrene matter and air quickly act upon it and set up 
decomposition in it; the humours of the body therefore undergo 
putrescence, and obstructions arise in the chest and the voice 
becomes husky. 

374. Some say that the reason for the putrescence is 
that rain water is formed from the vapours which evaporate off 
from various kinds of moisture. But were this the case, rain 
water would not be laudable but uncommendable, and that is not 
so. The real reason is that the substance of rain water is very 
rarefied and tenuous, and when a substance is tenuous it has 
more receptivity (and is therefore liable to putrescence). But if 
boiled promptly, this risk of putrescence is lessened. (Aegineta 
adds : rain water is very light, sweet and limpid ; it is tenuous 
because it has been drawn up by the heat of the sun, and there- 
fore only the lightest particles of sea-water, lake-water enter into 
it). Rain water is soft to the touch. 

375. Well tvater and water conveyed along aqueducts. 
These are of bad quality as compared with spring water, because 
they are confined and have been exposed to earthy matter for a 
long time, and consequently cannot help being to some extent 
putrescent. For in the process of being drawn, they are shaken 
up by the power entailed (that is, by the mechanical contrivances 
used) or by the influence of gravity rendered possible by the 
slope of the channel. Of such waters those which are conveyed 
by leaden pipes are more harmful, because they acquire certain 
properties from the lead, and this makes them liable to bring on 
a form of dysentery. 

376. Snow water and water from melted ice. These are 
coarse m texture. When pure and free from admixture with 
deleterious substances, such water is good and healthy ; it is also 
useful for cooling water, either by placing such water in it, or by 
adding it to the water. There is little difference in the visible 
character of these two kinds of water ; but they are denser in 
texture than other kinds of water [because the finest particles are 
squeezed out by the freezing (Aegineta)]. This kind of water 
is harmful for persons suffering from neuritis. Boiling renders 



226 THE CANON OF MEDICINE 

such water wholesome. If ice water be made of bad water or if 
the snow has attracted some bad property from the places upon 
which it has fallen, it would be better to use. water free of such 
injurious admixture. 

River water was preferred before others by Rhazes ; Aetius preferred Nile 
water to all others (see 370). 

Spring water : the qualities vary according to whether the water comes from 
north, south, east or west (Hippocrates) . 

Non-Commendable Waters. 

377. Marshy water : This is of worse quality than well 
water because it stays a long time putrefying in the channels of 
the decomposing earth, and diffuses out and moves up very 
slowly, and then not by its own power, for it is so rich in (alluvial) 
matter. Moreover, it only occurs in decomposing decaying 
earth. Well-water on the other hand is cleansed by contact 
with that which separates out from it and by the gases which 
bubble up out of it, thereby keeping it in constant (molecular) 
movement. Well-water does not remain in a confined state long 
and does not linger in the channels and openings of the earth. 

. 378. Stagnant water : Water in reedy marshes. This is 
unhealthy and heavy, especially if in exposed situations, for these 
do not become cold in winter unless and only in so ^ far as snow 
happens to fall on them. They therefore give rise, in the body, 
to serous humour. In summer, the sun makes them hot and so 
they putresce and then they will give rise, in the body, to bilious 
humour. There are three reasons why they cause disease : 
(i) their inspissated character ; (2) admixture with earthy 
matter ; (3) dispersion of their subtile particles. 

379. The following are the diseases liable to develop after 
drinking such water : (a) diseases of the spleen. These result 
in heaping up of the viscera and stretching of the peritoneum — ■ 
the belly being hard and tense ; wasting of the arms, legs and 
neck — for the nutrition fails because of the state of the spleen 
despite the excessive appetite and thirst ; constipation ; vomit- 
ing is difficult to induce, (b) dropsy : from retention of the 
water, (c) inflammatory deposits in the lung and spleen, (d) 
"dysenteric ailments, with the result that the hands and feet 
become dry, and the liver becomes enfeebled and nutrition is 
impaired, ' (e) quartan fevers (in summer), (f) piles, varices, 
lax swellings of inflammatory nature, insanity (especially in 
winter). 

380. The effect of such water on women. Conception and 
parturition are both difficult. The offspring will be male and 



THE CANON OF MEDICINE 227 

will be liable to develop inflammatory masses and then waste 
away. — Moles are liable to occur because impregnation is often 
faulty ; the offspring is found to" have rupture. — Varicose veins 
and ulcers of the leg ; these heal with difficulty. The appetite 
increases and there is constipation leading to intestinalulceration. 
Quartans are common. 

381. Effect on old persons. " Ardent " fevers occur, as 
accords with the dryness of their nature, and of the stomach. 

382. All stagnant waters, from whatever source, are 
injurious to the stomach. 

383. Channel water. This is very like stagnant water, but 
is healthier because it does not linger so long in one spot. If it 
is not actually flowing, this was because of some heaviness in it. 
In many of these waters (i.e. including water in aqueducts, water 
in irrigation channels) there is a certain stypticity, and they 
quickly warm the interior organs. Hence they are not utilisable 
in cases of fever or for persons in whom the bilious humour is 
predominant. They are more applicable for cases of disease 
where the treatment is to foster retention and maturation, 

384. Waters containing metallic, substances. These are 
injurious, though in some cases there is a certain value in them. 
Thus, ferruginous waters impart strength to the internal organs, 
prevent stomach trouble, and stimulate the appetite. They 
resolve the spleen and are beneficial for those who cannot cohabit 
properly. 

Waters containing salts of ammonia are aperient, and 
carminative. They may be either swallowed as a drink or given 
as an enema, or used in a sitz-bath. 

Waters containing alum suppress excessive menstruation 
and haemoptysis and the bleeding of piles. But they render 
persons who are liable to take fevers still more liable to develop 
them. 

385. Waters in which leeches live. These are injurious. 

386. Salt water. This makes the body dry up and 
become wasted. Its abstersive power makes it first laxative, 
and afterwards constipating — because dry in nature. It 
decomposes the blood and so gives rise to pruritus and 
" scabies." 

387. Acetous water, added to rain water which has to be 
consumed arrests putrefactive changes in the water and provides 
immunity from such ill-effects. 

388. Milky water gives rise to calculus and obstructions. 
Hence one should make use of diuretics after it. In fact, one 



228 THE CANON OF MEDICINE 

should take diuretics after drinking any coarse and heavy waters, 
because they linger in the bowel. Fatty and sweet things (e.g. 
theriacs) are also correctives for such water. The fact that 
milky water brings on constipation makes it of value for some 

persons. 

389. Cold water. — Water which is only moderately cold 
is more healthy than all others, because it stimulates the appetite 
and strengthens the stomach. Nevertheless it weakens the 
nerves and is harmful for cases of inflammatory disease in the 
interior organs. 

[Very cold water should be taken after food and then only 
in small quantity (Aegineta).] 

390. Tepid water incites nausea. 

Warm water (that is, water which is a little warmer than tepid 
water), taken on an empty stomach, is cleansing both to stomach 
and intestines. But it has a weakening effect on the stomach if 

taken often. 

Hot water is beneficial for the following conditions : 

(a) Head : " cold " headache ; inflammation of the eye ; 
parotitis, quinsies; " dry " gums ; postauricular inflammations. 
Mental conditions — epilepsy and " melancholia." 

(b) Chest : asthma, solutions of continuity in the thorax ; 
ulcers of the diaphragm. 

(c) General : rheumatic pains. Diuresis. It relieves 
painful micturition. 

(d) Female ailments : it evokes menstruation. 

Hot water interferes with digestion and makes the food 
swim about in the stomach. It does not quench thirst. It may 
lead to dropsy, and hectic fever, and emaciation. 

Very hot water is of great, value in colic ; it also disperses 

flatulence. 

391. Aerated waters : these are useful for certain in- 

temperaments. 

When various kinds of water, good and bad, are com- 
mingled, their effect varies according to which proves dominant. 

392. Correction of impure water : The correction of impure 
water is specially referred to under " regimen for travellers " — 
see 891. 

Note also the following, from Aegineta: (i) add decoction of chick-peas; 
(2) boil wild carrots with some small fish and fennel ; (3) beet, gourds, salts and 
diluted wine. Marshy, saltish and bituminous water should be strained, -betid 
smelling waters should be boiled or mixed with wine. _ 

When good and bad waters are mingled, the stronger dominates. 

Other matters relative to water and its properties and 



THE CANON OF MEDICINE 229 

modes of action will be discussed in the- chapter on " Water as 
one of the simples " in Book II — Allah permitting. 

17. The Results of Retention and Evacuation.* 
393. The following are the causes of retention of waste 
matters : (1) weak expulsive faculty, (2) unduly strong retentive 
faculty : the latter occurs in (a) weakness of digestive power, so 
that aliments remain too long in the stomach, the natural reten- 
tive faculty holding them back till they are sufficiently digested, 
(b) narrowness and (V) obstruction of the channels, (d) coarseness 
or viscidity of the waste matters. The former holds in the case 
of (a) superabundance of the waste matters, so that the expulsive 
faculty cannot deal with them, (b) insufficient informing sense for 
defecation, this act being aided by voluntary effort. The result 
may be that the effete matter is (compensatorily) removed to 
other parts of the body by the action of the vegetative faculties. 
Thus jaundice follows [gall-stone] colic ; the colic depends on 
the retention, the jaundice is the compensatory evacuation. 
Again, at the crisis of a fever, there may be retention of urine 
and faeces, and a critical evacuation occurs elsewhere. 

394. Diseases consequent upon retention of waste matters. — ■ 
(i) Compositional : constipation, diarrhoea or laxity of the 
bowels, spasmus humidus and the like ; inflammatory processes ; 
furuncles, (ii) Intemperaments : septic conditions ; imprison- 
ment of the innate heat, or mutation of this into igneity. There 
may be so marked a coarctation that the innate heat is extin- 
guished altogether, and coldness of the body supervenes, with 
the transference of too much moisture to the surface of the body, 
(iii) General conditions : tearing or rupture of Jocular spaces and 
crypts. 

When repletion (as from great plenty during fertile years) 
develops after a long period of inanition (as from times of great 
famine, in barren years), it is one of the most effective causes of 
such illnesses. 

395. — The causes of the evacuation {depletion) of matters 
which jire normally retained. (1) Vigorous expulsive faculty, 
{2) defective retentive faculty, (3) unfavourable quality of the 
matter: (a) too heavy, because superabundant, (b) too distending 
owing to flatulent action, (c) corrosive and acrid in quality, 
(d) attenuation of texture making it too mobile and too easily 
expelled, (4) widening of the excretory channels. This occurs 
in the case of the seminal flow. It also occurs if they are torn 

* Cf., repletion and depletion (442, 497, 502). 



23 o THE CANON OF MEDICINE 

longitudinally or transversely, or because their orifices become 
too patent (in epistaxis) , from either extraneous or interior 



causes. 



396.— -The possible effects of evacuation ot this type are_ : 
(i) The temperament becomes cold, because the matter is 
lost which would otherwise increase that which maintains the 
innate heat. (2) The temperament becomes hot, if the evacuated 
material is cold in temperament, like serous humour or mucus. 
(fl The temperament becomes equable like blood, if there is 
undue accumulation of the heating bilious humour, so that the 
heat becomes superabundant. (4) The temperament becomes 
dry. This is always intrinsic in origin. (5) The temperament 
becomes moist in a manner analogous to that mentioned m 
regard to accidental increase in the body-heat. Namely, either 
the evacuation of desiccant body-fluid has not been too great, or 
the innate heat is too scanty, with the result that the aliment is not 
adequately digested, and serous humour becomes relative y 
increased. But a moist temperament of this kind is unfavourable 
to the maintenance of the innate heat, and foreign heat will not 
serve as a substitute for innate heat, because of the difference of 

its nature. " 

397* The effect of excessive evacuations on the members 
of the body.—- (1) Coldness and dryness of their substance and 
nature ensue, even though they receive extraneous heat, and 
moisture beyond their need. (2) Diseases : obstruction of the 
vessels due to undue dryness, and narrowing of the veins. 
Convulsions and tetanic spasms may therefore arise. 

398. When retention and evacuation are equally matched, 
and occur at the proper times, they are beneficial, and maintain 
the health. 

8 106 Venery. Coitus.— Galen placed this in the first rank among the obli- 
gatory causes of disease, but most physicians group it partly under exercise, and 
-Dartlv under "evacuations" (excretions). 

P It causes " dryness " of the body ; weakens the vegetative faculties m- 
frigidateE ^usually) Sometimes the concomitant emotional excitement entails 
a heating effect. (Joannitius). 

Having now given a general description of the obligatory 
causes of disease, we proceed to the facultative causes. 

• B. 18. FACULTATIVE CAUSES OF DISEASE. 

We now come to causal agents, not necessarily injurious, 

to which the body is not inevitably exposed. They cannot be 

classified either as natural or as contrary to nature. They 

influence the body from without. Excluding the atmosphere, to 



THE CANON OF MEDICINE 231 

which one is necessarily exposed, such agents are referred to as 
baths, friction, and the like., 

399. Influences on the human body from without act 
in these ways : 

I. By penetration into the body (400-414) 

(a) Attenuated matter in the pores enters the body by its 
own penetrative power. 

(b) The tissues themselves draw it in through the pores. 

(c) One of these factors assists the other. 

II. The primary quality of the agent itself is able to 
produce a change in the body. (415-431.) There are three 
aspects of such a quality : 

(i) It may be actual, e.g., an epitheme of cooling 
character ; a plaster which is calefacient. 

(ii) It may be potential. Here the innate heat stirs up 
the power into actuality. 

(iii) A specific property. 

III. Things acting in both ways (a) producing a harmful 
effect both externally and internally. (P) Harmful when applied 
externally, but not when taken internally ; and vice versa. 

Example of an agent which affects the body when applied 
externally, but harmless when taken by the mouth : onions 
applied as a plaster cause ulceration ; as food, they are harmless. 
Example of an agent of a contrary kind : white lead. This is a 
virulent poison when swallowed, but is harmless when applied 
as an ointment. 

Explanation of this. — (1) When a substance like onions is 
taken as food, the alterative faculty breaks it up and changes its 
temperament into a weaker one, until it is too weak to exert a 
harmful influence. Hence there is no internal ulceration. 
(2) When taken as food, such a substance is usually admixed 
with other foods. (3) Its power is broken by being submerged 
in the other moist substances present in the alimentary canal. 
(4) A substance applied externally can be kept in one spot, but 
when it is within the stomach it is kept moving about. (5) A 
substance applied externally is usually applied very tightly and 
closely, whereas within the body it is only just in contiguity 
without any adhesion. (6) When a substance is taken internally, 
its own natural power determines the quick accomplishment cf 
digestion and quickly expels the excess lert after the bulk has 
been converted into good blood. 

The reason why the action of white lead is different is that 



2 32 THE CANON OF MEDICINE 

white lead is of gross nature and is made of coarse particles. 
Hence it cannot penetrate, into the channels of the body from 
without, and even if it did enter the skin it would not reach as far 
as the channels of the breath or the principal organs. Taken in 
by the mouth the matter is different, for then its poisonous 
nature is at once brought out by the influence of the innate 
heat upon it. Such an interaction could not take place ex- 
ternally. 

We shall probably refer to these considerations again, in 
the Book of Simples. (Book II). 



BALNEOLOGY 
I 

19. Baths. Friction. Exposure to the Sun. 

§ 197. Points Relative to Water-Baths. 

The bath-rooms : temperature of the air in the different rooms (temperate, warm, 

hot, cool) ; mural decorations. 
The bath-man. 
The bath itself : 

Quantity of water : full to immersion ; partial ; sitz, etc. 

Temperature of water : hot, tepid, cold. 

Duration of stay in the bath : long, short, medium. 

Kinds of water employed. 

Intrinsic quality (cooling, moistening, etc.) 
The person bathing : relation to food : fasting or hungry ; immediately after a meal ; 
soon after a meal ; at the end of the first stage of digestion. 

State of the skin : dry, moist ; dropsical. 

State of the humours and their quality (cold, immatured). 

Frequency of bathing. 

Season for open-air bathing. 
Effects of the bath : 

On respiration. 

On pulse. 

On innate heat. 

On the strength (relaxing effects ; syncope; impotence). 

On the humours : helping maturation ; drawing to surface ; diverting super- 
fluities to different parts. 

On the quality of the body ; dry, cold, moist. 

On the general nutrition : making the body thin, stout, or weak. _ 
Special purposes of the bath. Treatment of hectic fevers ; for affections of the 
stomach and spleen, etc. 

400o Some say that bath-houses should be ancient fine 
buildings, with vaults and arches, and roomy, airy, spacious 
galleries, and furnished with sweet water. Others mention that 
the bath-men should arrange the degree of heat to suit the tem- 
perament of the bather. 

§ 198.— The bath-house, the hammam, of Arabian life, agrees in 
manner with that described among the ancients (e.g. the Romans). 



THE CANON OF MEDICINE 233 

In Lane's notes to the " Arabian Nights," he gives the following 
description : — " The public bath comprises several apartments, with 
mosaic or tessellated pavements, composed of white and black 
marble, and pieces of fine red tile, and sometimes other materials. 
The inner apartments are covered with domes, having a number of 
small, round, glazed apertures, for the admission of light. The 
first apartment is the disrobing room (mas lakh, or stripping-place : 
Burton). (Tepidarium, because the air is tepid.) In the centre of this 
is a fountain of cold water. Next the walls are wide benches or plat- 
forms, encased with marble. These are furnished with mattresses and 
■cushions for the higher and middle classes, and with mats for the 
poorer sort. The inner division of the building occupies nearly a 
square : the central or chief portion of it is the principal apartment, or 
hararah, which generally has the form of a cross. In its centre is a 
fountain of hot water, rising from a base encased with marble, which 
serves as a seat. One of the angles of the square is occupied by the 
ante-chamber of the hararah. A second angle has the fire and the 
boiler over it. A third angle has a small chamber, containing 
a tank of warm water fed by a spout in the dome (cf. calidarium). 
The fourth angle has two taps side by side, one hot, one cold. A 
small trough is beneath, and before that is a seat (cf. frigidarium). 
The inner apartments are heated by the steam rising from the 
fountain and tanks and by the contiguity of the fire. The chamber 
of the first-named angle is not as hot as the hararah, and has a 
door intervening. This chamber is used for disrobing in cold 
weather. 

" In their atmosphere, the four apartments of the Hammam 
represent the four seasons — Autumn and Summer, and Winter and 
Spring.". (Night 452). 

" The bather enters the hararah wearing wooden clogs, a large 
napkin round the loins, a second round the head like a turban, 
a third over the chest, and a fourth covering the back. The attendant 
removes the towels except the first, and proceeds to crack the joints 
of his fingers and toes, and several of the vertebrae of the back and 
neck ; kneads his flesh, and rubs the soles of his feet with a coarse 
earthen rasp, and his limbs and body with a woollen bag which 
covers his hand like a glove. After which the bather plunges 
into the tank. He is then thoroughly washed with soap and water, 
and fibres of the palm-tree, and shaved, if he wish it, in the fourth 
chamber. Then he returns to the antechamber, and here he gener- 
ally reclines upon a mattress, and takes some light refreshment, 
while one of the attendants rubs the soles of his feet, and kneads 
the flesh of his body and limbs, previously to resuming his dress. 
During this period of rest, a pipe and a cup of coffee is often taken. 
The operations in the antechamber are the ' restorative friction ' 
of the text and of Greek and Roman baths. Before the dress is 
resumed, oils or ointments are rubbed in, and fragrant powders 
sprinkled on the skin." 



234 



THE CANON OF MEDICINE 



Rooms in the private baths of the Alhambra Palace, (a) The Sultan's bath. 
Through the archway on the left is seen (6) the Calidarium. The " rest-room " of 
the same suite is shown as an " initial " to 751. 



§ 199- — 'Sir Thomas Arnold, in his recently published work, 
" Painting in Islam," 107 (1928, p. 88) quotes some medical authors 
who speak of the propriety of mural decorations in the rest-room. 
(a) The ideal bath " should contain pictures of high artistic merit 
and great beauty, representing pairs of lovers, gardens, beds of 
flowers, fine galloping horses and wild beasts, for pictures such as 
these are potent in strengthening the powers of the body, whether 
animal, natural, or spiritual." (b) " All physicians, sages, and wise 
men are agreed that the sight of beautiful pictures gladdens and 
refreshes the soul, and drives away from it melancholic thoughts 
and suggestions, and strengthens the heart more than anything 
else can do, because it rids it of all evil imaginings." (c) " Beau- 
tiful pictures in bright, cheerful colours. These they divide into 
three kinds since they knew that there are three vital principles 
in the body — the animal, the spiritual and the natural. Accordingly 
they painted pictures of each kind, so as to strengthen each one of 
these potentialities ; for the animal power they painted pictures 
of fighting and war and galloping horses, and the snaring of wild 
beasts. For the spiritual power, pictures of love and of reflection 
of the lover on his beloved, and pictures of their mutual recrimina- 
tions and reproaches, and of their embracing one another ; and 
for the natural power, gardens and beautiful trees and bright flowers." 
(d) " When in a beautiful picture harmonious colours such as 
yellow, red and green, are combined with a due proportion in their 
respective forms, then the melancholy humours find healing, and the 
cares that cling to the soul of man are expelled, and the mind gets 
rid of its sorrows, for the soul becomes refined and ennobled by the 
sight of such pictures." 



THE CANON OF MEDICINE 235 

401. Natural action of the bath. The air of the bathroom 
has a warming action, the , water of the bath has a moistening 
effect on the body. The first change in the body is to cool and 
moisten ; the second is to warm and moisten ; the third is to 
make the body warm and dry. It is useless to listen to those who 
assert that water taken internally does not moisten the interior 
tissues. 

402. Changes and later effects of the bath. These are (a) 
accidental, (b) essential. 

1. Cold air bath. — This disperses the innate heat greatly, 
and so dries the substance of the tissues. It disperses the natural 
(normal) fluids very greatly, though it increases the extraneous 
fluids. 

2. Very hot water bath. — The pores close ; there is goose- 
flesh. The moisture does not enter the body, and there is not 
much dispersal of the innate heat. But the water sometimes adds 
to the warmth of the body and sometimes cools it. To have the 
former effect, the water must be very hot. 

3. Subtepid bath. — This cools and moistens the body. As 
the water cools down, the air of the bathroom becomes less 
warm, and the effect of the cooling in both directions to which the 
body is now exposed is to contract the abdominal viscera. 

Cold bath.— When taken while fasting, it imparts warmth and moisture If 
taken after a meal, it will make the body cold, and remove moisture 

_ Hot bath.— When taken while fasting, it is attenuant and refrigerant and does 
not impart moisture If taken after a meal, the bath is heating and moistens the 
body. — (Hippocrates.) 

Warm bath.— This relieves lassitude, is soothing, and has a warming and 
softening effect. It dispels plethora, and removes flatulence from wherever it may 
have lodged It favours sleep, and promotes digestion.— (Haly Abbas.) It opens 
the pores It induces plumpness of the body. It is beneficial for all— men, women 
young, old, rich, poor. The best time for it is before food, and after exercise — 
(Aegmeta.) 

403. _ The frequent use of such a bath will have a refrigerant 
effect. This is because (i) water is fundamentally cold in nature, 
and even warming of it will not ensure continuance of the 
" accidental " (scholastic significance) heat, the natural quality 
remaining, and this natural coldness enters the body and makes it 
cold, (ii) Whether hot or cold, water is still " wet," and wets the 
body (interiorly), so, imparting much moisture, it binds the 
innate heat even to the degree of extinction.* Consequently 
the body becomes cold. 

Such a bath may have a warming effect if (a) the. aliment 
previously taken has not yet digested, (b) there is a cold humour 

* As water quenches fire. 



23 6 THE CANON OF MEDICINE 

present in the body which is not yet completely matured. For 
the bath will help the digestion of the aliment, and the maturation 
of the humour. ■ . 

404 Sw/* 0/ j&» <tf /^ /«»* 0/ /£* bath.— If the skin be dry 
at the time of the bath, dropsy or relaxed conditions would be 
benefited. If the skin be moist to commence with, the bath will 
have a moistening effect. 

405 Duration of stay in the bath. — Dryness results it the 
person stay a long time in the bath. This is partly because of loss 
of water by the sweating and with the dispersal of the breath so 
induced. 'A short stay-in the bath will produce a moistening 
effect, if the skin be wiped dry before sweating begins^ 

406 Relation to meals.— To enter a bath fasting will 
render the body extremely dry, and make the person thin and 
debilitated. To enter the bath after a heavy meal, on the other 
hand, will make a person stout, by drawing the humours towards 
the subcutaneous tissues. Moreover it removes the obstructions 
by transferring the undigested aliment from the stomach to the 
tissues. To enter the bath at the moment when the first digestion 
has ended and before a sense of hunger returns is beneficial and 
produces a medium degree of stoutness. 

407 Special therapeutic uses. Bath treatment of hectic fever. 
—If the bath is taken for a moistening effect the person should 
be entirely immersed in the water, unless he is too enfeebled or 
his strength will not allow of it. The air of the room should be 
temperate— neither hot nor cold, but gently moist. The water 
of the bath should be thrown freely about in order to disseminate 
the water-vapour through the air and so fill the air with moisture 
The duration of the bath should not be long. The patient should 
be lifted out of the water and rubbed down gently, himself 
making no exertion ; and he should be laid at once on the couch 
(in the bathroom^ and there be anointed with oil (to increase the 
moisture of the skin and retain in the pores the aquosity which 
has already gained entry into the skin, thus fixing it within the 
skin^ using cool perfumed oil. He should then he in. the 
tepidarium (the disrobing room) for an hour until the respiration 
subsides to the customarv rate. After that, he is anointed, robed, 
and taken into a room (dining-room, 1595 ed.) where he may 
receive a small draught compounded of humectants, such as 
barley water and asses' milk. . 

' Disadvantages.— Such patients should not stay too long in 
the bath, as there is a risk of syncope, because it renders the heart 
" hot " (and therefore disperses the " breath ") and sets the 



THE CANON OF MEDICINE 



237 



bilious humour in motion ; it produces nausea ; and other ill- 
effects. It causes morbific matters to gravitate into the debilitated 
organs. It has a relaxing effect and is injurious for the nerves. 
It disperses the innate heat. It removes the appetite for solid 
food. It weakens the power of sexual intercourse. 

[Aegin'eta says : natural baths are largely desiccant and calefacient, and are 
therefore good for people of humid and cold temperament]. 

408. Action of baths in virtue of mineral constituents in the 
water. — Waters of this kind occur in nature, or may be repro- 
duced artificially. They are all strongly resolvent and attenuant. 
They make the tissues flabby, and prevent humours from passing 
into abscesses. They are beneficial for the guineaworm and 
" Indian vein." 




Mineral Baths in the Middle Ages 12 (p. 270). 

Aluminous waters [Alum=MgS0 4 +FeS0 4 : "hair-alum," 
according to Adams 74 ] benefit cases of haemoptysis, melaena, 
menorrhage, procidentia ani or uteri, repeated causeless mis- 
carriage, cachexias, undue sweating, causeless vomiting. They 
have a cooling and drying effect. 

Bitter waters have a heating and drying effect. 

Bituminous waters ("judaic waters ") occasion fulness of 
the head. The person must therefore not immerse his head in 
the bath or stay too long in it. They render the temperament 
warmer, especially that of the uterus, bladder and colon. They 
are all harmful and heavy. [They soothe if persevered with: 
Aegineta.] 



2 3 8 THE CANON OF MEDICINE 

Chalky waters have a cooling and drying effect. 

Copper-containing waters are beneficial for the mouth, 
tonsils and uvula ; for relaxed ocular tissues ; for humid 
affections of the ears. 

Ferruginous waters are beneficial for the stomach and 
spleen. . (They should be entered gradually so as to allow the 
impression of the water to sink deeply into the body while it is in 
a relaxed state : Aegineta.) 

Medicinal baths, prepared with laurel leaves, stavesacre, 
juniper berry. 

Nitrous (=Na 2 CO s : Adams 74 ) baths and saline baths are 
beneficial for the head and chest when humours are constantly 
flowing into them ; for wateriness of the stomach, for dropsy, for 
swellings left after diseases, and for collections of phlegm. 

Aerated waters, ferruginous and saline waters are beneficial 
for diseases depending on coldness and moisture, for pains in 
the joints, for podagra. They benefit relaxed persons, asthma, 
renal disease, carbuncles, ulcers ; they are very beneficial in 
cases of fracture. 

Sulphur baths. These soothe and warm the nerves and 
relieve pain, lassitude and convulsions. They cleanse the 
surface of the skin from furuncles and old bad ulcers and purple 
marks ; they benefit pannus, vitiligo, lepra. They disperse 
morbific matters descending into the joints, the spleen and the 
liver. They are beneficial for the womb when unduly hard. 
They reduce the tone of the stomach and banish the appetite. 

409. Thermal baths. — Persons desiring to use thermal 
baths should bathe quietly, gently, and allow the waters to play 
gently over the relaxed body ; laving, not splashing ; and in this 
way the interior organs are benefited. 

The subject of baths will be considered further in Part III, 
and again when discussing the use of cold water as a drink. 

2,0. The Influence of Sunbaths ; Sandbaths ; Oilbaths ; 

Showerbaths. 

41 0„ Immersion in hot sand, oil baths, spraying of water 
over the face ; standing or running or walking rapidly, or 
jumping in the heat of the burning sun — all these are powerful 
agents for removing superfluities, and for producing sweating, 
dispersing flatulence, and lax swellings and dropsies. They are 



THE CANON OF MEDICINE 239 

beneficial for asthma, for orthopnoea. They invigorate the brain 
(whose temperament is cold) and relieve inveterate " cold " 
headache. 

If the seat of the bath is dry, and the floor is left wet, the 
bath will benefit cases of sciatica, lumbar pain, uterine obstruc- 
tion. It has a cleansing effect on the womb. 

411. Sun-baths. — One must not remain too long in the 
sun, or else the body will become dry, thick, and hard, as the sun 
acts like a cautery upon the pore's of the skin, and obstructs the 
outflow of the insensible perspiration. The sun burns the skin 
more if one stands still in it, than if one moves about, and 
so it inhibits the dissipation of the sensible perspiration still 
more. 

412. Sea-sand baths, in the sun, — These are more efficient 
for drying the humours lodged in the skin. Such a bath may be 
used in various ways : one may sit on the sand, or" bury oneself in 
it, or sprinkle it over the body. In whatever way it is' employed, 
the same beneficial effect is experienced in all the above-named 
diseases. If the sand is sprinkled over the body, little by little, it 
removes pains and other effects of insolation. In the end, there 
is an extremely marked drying effect on the body. 

413. Oil-baths. — These are beneficial in lassitude and 
for persons suffering from long-standing cold fevers, especially 
if there are pains in the nerves and joints ; for convulsions ; for 
spasmodic diseases ; for suppression of urine. The oil must be 
made hot outside the room. These baths are more beneficial 
for the above conditions if the flesh of the jackal or hyssna is 
boiled in iL If made as described, it will be an efficient remedy 
for joint-pains and podagra. 

Aetius gives : add a fifth part of heated oil to the water. Such a bath is highly 
anodyne ; it relieves lassitude and nervous pains. Uses : for prolonged fevers • 
for convulsions ; for retention of urine. ' 

414* Shower-baths, Douching, Spraying. — If water be 
sprinkled on the face (or over the body) it restores the vigour of 
the breath, when that has been lost by dyspnoea and by the 
inflammatory changes in hot fevers. .This sprinkling is especially 
beneficial for syncope, if rose water or vinegar be used. It 
may restore the appetite. They are injurious to persons suffering 
from catarrhs or " cold " headaches. 

"He swooned away, and the Wazir sprinkled rose water on him till the 
Prmce came to himself."— Night, 720 ; Burton, iv. 408. 

Douching with emollient herbs is referred to in 719, 732. 



2 4 o THE CANON OF MEDICINE 

II 

The Agents which alter the Several Qualities of the 

Body. 

i. Calefacients. 

2. Refrigerants. 

3. Humectants. 

4. Desiccants. 

5. Agents causing changes of form. 

6. Agents causing obstructions of channels. 

7. Agents which, open up the channels. 

8. Agents causing roughness. 

9. Mollificants. 

10. Agents causing displacements of parts. 

11. Agents preventing apposition of parts. 

12. Agents preventing expansion of parts. 

13. Agents causing abnormal movements. 

14. Causes of numerical increase. 

15. Causes of numerical decrease. 

16. Causes of loss of continuity. 

1 7. Causes of ulceration. 

18. Causes of inflammatory swellings. 
19-26. The subject of pain. 

27. Agents producing retentions or evacuations. 

28. Causes of over-repletion. 

29. Causes of debility ; asthenia ; lack of vigour in members. 

415. — I. Calefacients. 

(i) Outward heat in various forms : summer heat ; artificial 
heat ; baths of moderate temperature (the heating effect is produced 
by both air and water) ; calefacient plasters or local applications. 

(ii) Heat produced by movement. Exercise, but not in excess ; 
gymnastic exercise which is not too vigorous or beyond the right 
measure and duration ; moderate friction ; light massage with the 
hands on the limbs ; dry cupping (wet cupping is infrigidant because 
it removes heat from the body). 

(hi) Heat introduced b'y the mouth. Adequate supply of nutri- 
ment •/ hot aliments; hot or heating medicaments (i.e. via 
oxidation within the body.) 

(iv) Heat arising from emotional states : anger, gloom in a 
degree less than would cause infrigidation ; moderated joy. Also 
sleep and wakefulness in moderate degree. 

(v) Heat derived from putrefactive processes. This is neither 
the innate heat nor derived from combustion. The warming _ from 
the innate heat is less in degree than that from combustion ; it can 
occur apart from putrefaction and prior to a septic state. In the 
case of putrefaction the heat from the foreign source lingers in the 
body after the agent giving rise to it has left the body. This heat 
unites with the moisture of the humours and alters their temperament 
(in respect of moisture) in such a manner that it will no longer 
respond to the temperament of the natural breath. The difference 
between digestion and putrefaction is that in the case of digestion 
the heat and moisture which are present in matter are altered ; 
that is, instead of being accordant with the original temperament, 
they are now accordant with another different one (J>). 



THE CANON OF MEDICINE 241 

In oxidation, moist substance is separated from dry by sub- 
limation and evaporation, the dryness going into the residue. 

In the process of simple calef action, the humours simply become 
warmer without losing their natural breath. 

(Galen's classification into five groups is represented by i, ii, 
iii, iv and v of the above list.) 

(vi) The state of the body. When there is sclerosis (takathuf) 
of the surface, the body tends to become hot because the breath 
(lit.. the steam, bakhr) is held in or imprisoned. When there is 
rarefaction (takhalkhal) within the body, it becomes warm because 
the " breath " (bakhr) then expands throughout the body. 

The above section has been partly rearranged. The sub-headings are intro- 
duced, as usual, for the sake of clearness. 

Sclerosis. — This refers to the thickening of the skin, which occurs after long 
exposure to the weather ; it becomes harsh, coarse, and presumably less pervious. 

Steam. — Horses " steam " when they have been hard-worked. The exhaled 
air appears like " steam." The urine and shed blood steam when they leave the body. 
This steam is the substance of the breath, so that it is permissible to translate the 
word accordingly. This steam, which pervades organs and tissues and tissue- 
spaces and cavities, is the visible manifestation of the breath. 

It is natural to think, then, that if the skin is so hardened that it will not let 
this vapour out, the latter will accumulate in the body and make it hot, as happens 
after severe exercise until the body " cools down." It is also natural to reason 
that if the vapour is able to expand owing to laxity of the connective tissues, it will 
impart a sense of glow to the body ; for everyone has experienced it. 

Rarefaction. — When this term is applied to the skin it refers to a condition 
opposite to " sclerosis " ; the skin is unduly soft, supple, and is evidently relaxed 
instead of tight. 

These considerations apply to sub-heading 5 of 416. See also 838. 

§ 200. In modern language, the warmth of the body depends on 
the relation between heat loss and heat gain. Heat enters the body 
from (a) the external air or surroundings : warm air of summer, 
artificially warmed air in winter, baths ; (b) heat derived from (i) food 
and drink, (ii) exercise, (iii) toxic action of foreign matter (sepsis, 
drugs); (c) heat fostered by preventing heat loss: clothing, sleep; 
(d) local heat (fomentations, etc.) ; (<?) emotional influence. 

Heat is lost from the body by (a) excreta : urine, faeces, skin 
action, exhalation by the air expired ; (b) external conditions : 
cold, wet. 

Note that baths vary in their effect. An ordinary hot bath 
(105° F.) renders the body warm; a brief immersion has a different 
effect, a long continued immersion is depressant. 

416. 2. Refrigerants. 

1 . Artificial cold ; this is a refrigerant in act, as it is cold itself. 
. 2. Potential refrigerants. Thus, when the body is hot at the 
time of exposure to the agent, its heat becomes dissipated. Thermal 
waters. 

3. Calefacients. (a) Excessive : very hot air, thermal waters, 
hot plasters and fomentations (which disperse the innate heat by 

R 



2 4 2 THE CANON OF MEDICINE 

relaxing the body) ; ■ (b) moderate : staying too long in the bath ; 
(c) agents at present hot but becoming cold later. 

4. Excessive exercise : this disperses the innate heat unduly. 
Excessive repose aggregates and strangles the innate heat, thereby 
having an infrigidant effect. 

5. Certain bodily states, (a) Great rarefaction relaxes the 
body and. disperses the innate heat ; (b) extreme spissitudestrangles 
the 'innate heat ; (c) excessive retention (has the same action) ; (d) 
undue evacuation from the body, which destroys the material basis 
of the innate heat and disperses the breath, and allows the effete 
matters to become obstructions. 

6. Mental states : great gloom, too much fear ; too much joy ; 
great delight. 

7. Aliment. Excess of food and drink ; cold aliments ; too . 
little food ; refrigerant medicines. 

8. Mechanical causes : tight bandaging of limbs for some 
time, which prevents the innate heat reaching them. 

9. Crudity ; the opposite of putrefaction. 

(Galen's classification was : 4, 1, 3a, $b, insufficient food.) 

417. 3. Humectants. 

External : baths, especially if taken after a meal. 

Diet : food taken to excess ; humectant articles of food ; 
humectant medicaments. 

Retention of that which should be evacuated. 

Evacuation of desiccant humour. 

Repose and sleep. 

Joy in moderation. 

Infrigidants (these cause the humours to be retained) ; cale- 
facients (slight degree of warmth causes the humours to move). 

418. 4. Desiccants. 

External : cold congeals the humours and prevents the tissues 
from attracting nutritive material ; it also constricts the channels of 
the body, and so causes them to be blocked ; in consequence nutrient 
material cannot reach it. 

Great heat disperses moisture. Hence too frequent hot baths 
have this effect. 

Bathing in styptic waters has a desiccant effect. 

Diet : insufficient food ; dry aliments ; desiccant medicaments. 

Violent evacuations ; coitus. 

Exercise. 

Wakefulness. 

Frequent emotional disturbance. 

419. 5. Agents causing deformity. 

Some of these agents come into play from the beginning of life, 
because of a defect in the formative power of the sperm. Others 



THE CANON OF MEDICINE 243 

come into force later in life — namely at parturition, during the act 
of traversing the maternal passages. Others operate after birth 
(tight binders and wrappings). Others operate in infancy, before 
the limbs are hard enough to enable the infant to walk (letting the 
baby fall ; blows). 

Diseases which characteristically produce deformities : leprosy, 
paralysis, .nerve-lesions, phthisis. 

Excessive deposition of fat ; an excessive degree of emaciation 
(due to inflammation, or malposition, or from the coalescence of 
ulcers). 

420. 6. Agents causing obstruction of the channels. 

(i) Foreign bodies in a channel : ' calculus, (ii) Too great a 
quantity of material in a channel : loading with faeces', (iii) Altera- 
tion in quality of material : grossness, viscosity, leech-like coagula 
of blood, (iv) Formation of matter within the channels, whether 
removable therefrom or becoming fixed therein, (v) Obliteration 
of the orifices, (a) by cicatrisation after healing of an ulcer ; (b) by 
formation of new tissue (e.g. proud flesh, fleshy warts) ; (c) by com- 
pression by an inflammatory mass in the vicinity ; (d) by the 
astringent effect of great cold or dryness (styptics) ; (e) by unduiy 
marked retentive power; (/) by tight bandaging. 

Obstructions are common in winter, because that is the season 
when effete matters are largely retained, and because the cold itself 
has an astringent effect. 

421. 7. Agents which open up the channels. 

Channels become dilated either from lack of retentive power 
or from an excessive action of the expulsive facultv. For example 
holding the breath. Medicines which are relaxing, hot, moist' 
aperient and detergent. ' ' 

In short, all agents contrary to Group 6. 

422. 8 . Agents producing harshness of the body. 

. A medicinal agent may render the body harsh by its sharpness 
(acidity), like vinegar and acetous waste matters ; or by dispersion 
(like halcyonium= coral) and acrid waste matters ; or by styptic 
action (which produces roughness because 'it is dry ; ex. : bitter 
substances). 

Infrigidants have this effect, by inspissation. 

Terrene substances sprinkled over a limb like a dusting-powder 
may exert such an effect. 

423. 9. Mollificants. 

(Fatty or) glutinous substances act in virtue of their viscidity ; 
agents which mildly disperse the humours by attenuating them! 
cause them to flow, whilst at the same time they carry off the dense 
particles of matter in the apertures on the surface of the member. 



244 THE CANON OF MEDICINE 

424. io. Agents which produce displacements and luxations. 

Displacements of parts are produced (i) by extension — a force 
dragging on the member and pulling upon it until it is dislocated ; 
(2) by some unexpected violent movement, aided by the throwing 
of the whole weight of the body upon the member (e.g. luxation of 
the foot) ; (3) by some laxity or moistness in a part. This happens 
in tearing, in corrosion, or septic change or destruction of the sub- 
stance of a ligament or nerve — e.g. in elephantiasis, sciatica. 

425. 1 1 . Agents , which prevent parts from becoming 

apposed. 
Here belong — congenital factors ; grossness ; viscosity ; loose- 
ness of joints ; dryness of humour in a joint ; spasm ; ulcers which 
are only partially healed ; calculus. 

426. 12. Agents which prevent parts from expanding. 

Here belong — congenital factors, coarseness, spasm, cicatrisation 
after healing of ulcers. 

427. 13. The causes of abnormal movements. 

(1) Dry intemperament may cause weakness (e.g. dry tremor) 
or spasm (e.g. dry hiccoughs, or spasm). (2) Effete matters which 
heat, or cool the surfaces of the muscles. (3) Interception of the 
power which should have access to a member owing to some form of 
obstruction. (4) Nocumental effete matter acting in virtue of its 
coldness (e.g. rigor), or in virtue of pricking property (e.g. shivering), 
or in virtue of interference with the innate heat, making it either 
scanty or submerged, so that the surfaces of the muscles become cold, 
and gaseous matter forms which seeks to be dispersed or expelled. 
(Ex. : jerkiness, jactitation.) 

In such nocumental matter, further, gaseous matter may be 
deficient. This gives rise to the desire to stretch oneself. Or, 
gaseous matter may be in excess ; and in this case, if the matter be 
quiescent, one form of lassitude arises ; if the matter be mobile, 
other forms of lassitude will arise, which we shall describe later (821). 
If the nocumental character of the matter be more decided, shivering 
ensues. If very strong, rigors and spasmodic contractions come on. 
Should such matter which is held back in the muscles be gaseous, 
jactitation or pulsatile movements arise. 

428. 14. Causes of increase in size of body. 

Abundant supply of aliments ; great vigour of attractive 
faculties acided or not by friction or by calefacient plasters (e.g. 
plaster of pitch and the like). A powerful formative faculty will 
increase both the size and the number of tissue-components : e.g. 
proud flesh, supernumerary fingers. If pathological material* be 
formed, tumours, ganglia, " atheromas," steatomas, and warts will 
form. (Costaeus, quoting Galen.) 



~Y 



THE CANON OF MEDICINE 



H5 



15. Causes of numerical decrease. 

(1) Congenital: matter* lessened in amount; faulty or defective 
formative power. (2) Acquired : lack of nutrition during lactation 
or later ; direct injury — cutting wounds, blows, mechanical destruc- 
tion of tissue ; frostbite ; internal causes — eroding ulcers, septic 
processes. 

429. 16. Causes of loss of continuity. 

(1) Intrinsic : Pathological body-fluids, having a consuming, 
burning, moistening, relaxing, drying or cleaving action. Fluids 
which pierce and force themselves into tissues and stretch them apart. 
Gaseous matters also may force their way into, and stretch, tissues. 
In each of these cases, the effect produced depends on (a) the force 
of movement, (b) the abundance of the fluid or gas, (c) the greatness 
of the expulsive power. 

Similar in action to these are : vociferation, leaping exercises ; 
opening of abscesses. 

(2) Exterior. Traction by a rope or weight ; incision by a 
sword ; burning by fire ; contusion by a stone ; rupture of a sac 
by contusion ; perforation by an arrow ; punctured wounds (scorpion 
wounds) ; bites by a mad dog, a viper, or a human being. 

430„ 17. Agents producing ulceration. 

The rupture of an inflammatory mass ; of a pustule ; of an 
abscess. The bursting out of an ulcer. 

431. 18. The causes of inflammatory swellings. 

Causes relative to the material in a member : superabundance 
of the four humours ; aquosity ; gaseous matter. 

Causes in regard to the condition of a member. (1) Expulsive 
power. (2) Weak retentive faculty, which disposes it towards har- 
bouring waste matters. This varies with (a) the nature of the organ 
or tissue (e.g. the skin is so created) ; (b) the texture of the member 
(the looseness of the flesh behind the ears, in the neck, axilla, and 
groin is favourable — -to deposition of matter) ; (c) the width of the 
passages and orifices — too great and too narrow respectively ; 
(d) low position of outlet ; (e) small outlet, so that the food residues 
cannot get away. Some nocument may impair the power to digest 
the food material coming to the part. Blows may cause the matter 
to be retained in a member. Lack of exercise may prevent matters 
from being dispersed as they usually would be. Too much heat 
in a particular region may attract inflammatory processes — whether 
it be the natural heat of the flesh or an unnatural heat (causing pain) 
or heat produced by excessive exercise, or by some calefacient agent. 

Inflammation may follow fracture, if the limb has also been 
contused or crushed or stretched when setting the bone-ends. 

* i.e., humours. 



246 



THE CANON OF MEDICINE 



Inflammations often occur in connection with the teeth, as food 
may collect in them, undergo infusion, and so become putrefied. 
This may lead to an abscess. 



19-26. The subject of pai. 



ain. 



These separate Chapters are here gathered into one, with the following sub- 
divisions' : — 

General discussion of the causes of pain. 

Theory of the nature of pain. 

List of the types of pain, and the explanation of each. 

Agents which alleviate pain. 

The effect of pain on the body. 

The causes of pleasurable sensations. 

How movement brings on pain. 

How depraved humours evoke pain. 

How gaseous substances produce pain. 



1. 

ii. 

iii. 

iv. 

v. 

vi. 

vii. 

viii. 

ix. 




432. General discussion of the causes of pain. 

AIN is one of the unnatural states to which the 
animal body (as a sensitive and living thing) is 
liable. We begin with a general discourse 
about it. 

Pain is sensation produced by something 
contrary to the course of nature, and this 
sensation is set up by one of two circumstances 
(a) a very sudden change of the temperament ; or the _ bad 
effect of a contrary temperament, (b) a solution of continuity. 

In saying " the bad effect of a contrary temperament " we 
mean : the substance of the members of the body has a constant 
temperament, and then a foreign temperament of contrary 
character (hotter or colder) supervenes. The sensitive faculties 
become aware of the change ; this is " pain." The law is that 
there is no pain save as the sensation of contrariety produced by a 
contrary thing. A temperament which is constantly unhealthy 
does not produce pain, or arouse any sensation. That is to say, 
if the temperament residing in the substance of the members is 
bad, it destroys the original temperament so that the member is 
as if it had always had this unhealthy temperament ; consequently 
it neither produces pain nor is aware of it. The reason is that 
before sensation can occur, the sense organ must become affected 
by that which is sensed. But in this case the condition persists. 
There is no change. So there is no pain. Suffering will only 
occur if some contrary enters which, is able to alter the tempera- 
ment to one not previously present. 

That is why a person suffering from hectic fever does not 
suffer as much as one who has a one-day or a tertian fever, despite 



THE CANON OF MEDICINE 247 

the fact that the heat of the first is greater than that of the others. 
In the case of hectic fever the heat is persistent and situated in the 
substance of the principal members ; in the case of tertian, the 
heat comes from a hot humour, and so reaches those members 
which retain their natural temperament. Should the humour 
recede, the natural temperament will continue in the member, the 
heat not being fixed in it unless the fever become hectic. 

No inequable intemperament persists in a member except 
according to a certain rule. Such a state may arise during the 
best of health. Thus, should a person plunge into a bath in 
winter, and lave himself with tepid water, he would shiver ; 
which shows that it is harmful. For the primary quality of the 
body is far from that of the water, and indeed contrary. After- 
wards, however, it is beneficial and produces subjective satisfac- 
tion. The cold influence lessens step by step until no longer 
evident to the senses. 

But suppose the person were to sit in the bath-house 
another hour, the water would make his body hotter. And yet in 
spite of that, if this same tepid water of the above bath were 
suddenly thrown over him unexpectedly, shivering would result 
and the water would seem cold to him. 

If we study such things carefully, it will be clear that though 
unhealthy inequable intemperaments form one of the groups of 
causes of pain, yet not every one of such intemperaments actually 
does so. A hot temperament is in itself able to cause pain, and 
so can a cold one ; but a dry temperament causes pain only 
secondarily, and a moist one is painless. For heat and cold are 
both active qualities ; dryness and moisture are passive. So that 
in one case the impression on the body is active, in the other it is 
passive. 

Dryness is a cause of pain secondarily, if another kind of ■ 
agent comes into play, as e.g., loss of continuity. Dryness itself 
may be a cause of loss of continuity, in virtue of its power of 
producing great constriction of a channel. 

433. Theory of the nature of /pain. According to Galen, all 
this can be reduced to the one essential thing — loss of continuity 
and nothing more. A hot thing only causes pain by breaking 
continuity of a part ; a cold thing also only causes pain by 
breaking the continuity of function or of a part ; it exerts such an 
astringent and aggregating effect that the particles are drawn 
together towards a certain place and agglutinated ; and, in 
consequence separated off from their surroundings. In some of 
his writings, he seems to hold the opinion that all sensibles are 



24 8 THE CANON OF MEDICINE 

deleterious from the very fact that in order to experience a 
sensation there must be a cleavage of particles one from another- 
agglutination of some entailing cleavage of others ; ; the fact o 
cleavage accounting for the sensation called pain. A black 
obiect which gives a painful impression to the sense of sight does 
so because its blackness is due to an extremely close aggregation 
of particles ; whiteness is due to the particles being widely 

A bitter, salt, or sour thing, which gives a painful impression 
to the sense of taste, does so because such things produce vigorous 
dispersion of particles. Pungent things do so because they 
aggregate ver/vigorously, and are therefore no doubt followed 
bl dispersion. So too, with odours ; and sounds-where the 
movement of the air impinging in the external auditory meatus 
gives rise to a painful sensation. _ . 

To explain it according to my own view :— It is the trans- 
mutation of the temperament of a part which determines the 
presence of, and the kind of, pain lft^g *^^^ 
there is loss of continuity or not. This is best proved by Natural 
Science, but the following brief explanation may be given here. 
We mav therefore say : — 

Pain occurs in a member which is of homogeneous structure. 
Solution of continuity cannot occur except in members wh^W 
not of homogeneous structure. Pain occurs in states of the body 
where there is no loss of continuity of particles. Hence loss .f 
continuity is not a condition on which the appearance of pain 
depends. An intemperament will produce it. Cold produces 
pain if it constricts and agglutinates particles, and the part is 
cold throughout its substance ; solution of continuity does not 
occur at the site of infrigidation but at the distal parts of the 
infrigidated places. Again, pain is the sensation of a sudden 
impression by the contrary qualities. It is the fact that they are 
contrary, that accounts for the pain. . ,, 

Does one not observe how a person who experiences cold to 
a degree enough to alter the temperament will sense thechange 
in his temperament and also feel pain without there being any 
question of loss of continuity? where indeed such a loss is 
impossible ? It is clear then that a sudden change of tempera- 
ment will cause pain just as loss of continuity does Pain 
Souses heat, and affects the innate heat, and this makes the pain 
greater^still.^ ^ ^.^ ^ f g & s thing 

which provokes the sensation of pain. But it is not really pain. 



THE CANON OF MEDICINE 249 

It is a sum-total of .things which are undergoing spontaneous 
breakdown. 

A doctor ignorant of all this, and striving to relieve the pain, 
may make wonderful mistakes, and fail in his object. 

434. List of the types of pain and the explanation of each. 
There are fifteen kinds of pain* (rearranged alphabetically) : 



I. 


Boring 


6. 


Heavy pain. 


11. 


Relaxing. 


2. 


Compressing. 


7- 


Incisive. 


12. 


Stabbing. 


3- 


Corrosive. 


8. 


Irritant. 


*3- 


Tearing. 


4- 


Dull. 


9- 


Itching. 


14. 


Tension. 


5- 


Fatigue-pain. 


10. 


Pricking. ' 


i5- 


Throbbing 



1. Boring pain. The cause of this pain is the retention 
of gross matter or of gas between the tunics of a hard and gross 
member (e.g., the colon) and so continually goading it and 
tearing its parts asunder, boring into the interstices like a 
gimlet. 

2. The pain of compression. This is produced by fluid or 
gas, when it is confined in too small a space in a member, and so 
compresses or squeezes the tissues. 

3. Corrosive pain proceeds from the presence of material 
between the muscle-fibres and their sheaths, stretching it till it 
breaks not only the continuity of the membrane, but also that of 
the muscle therewith. 

■ 4. Dull pain. The cause is threefold : (1) the tempera- 
ment may be too cold ; (2) occlusion of the pores so that the 
breath (of the sensitive faculties) which should come to the 
member cannot do so ; (3) overfulness of the (locular spaces or) 
cavities. 

5. Fatigue-pain. This is produced (1) by undue toil — 
laborious toil, (2) by a humour which produces tension (in 
tensive lassitude), (3) by a gaseous substance which produces 
inflative lassitude, (4) a humour of biting properties (ulcerative 
lassitude). These pains may arise out of various composite 
states, as has already been stated in the appropriate places. 

* In regard to the kinds of pain, it is of interest here to recall the eight hinds 
of pain inherent in hiiman lije, given in the Nirvana Sutra : (i) Birth pangs (Shoku : 
Japanese; jatir-duhkham : Sanskrit); (2) The pains of age (Roku : jara-duhkham) ; 
(3) The pains of disease (Byoku ; vyadhi-duhkham) ; (4) The pain of death (Shiku ; 
marana-duhkham) ; (5) The pain of parting with loved ones or things (Aibetsuriku ; 
priyaviprayoge-duhkham) ; (6) The pain of meeting with what one dislikes (Onzoeku ; 
apriya samprayoge-d) ; (7) The pain of not obtaining what one seeks (Gufutokku) ; 
(8) The pain of the five elements ; that is, the body itself produces pain (Goonjoku). 
(The Sanskrit of the last two terms is length}'). — Ishizuka's notes to Honen. " 
p. 446. 



25 o THE CANON OF MEDICINE 

Lassitude as a result of several combined states, is called in 
flammatory lassitude, which is a composite of tensive and 
ulcerative lassitude (see 824). - 

6. Heavy pain. In this case there is an inflammatory 
process in an insensitive member such as the lung, the kidney or 
spleen. The weight of the inflammatory deposit drags on the 
tissues and surrounding sentient fascia and on its point of 
attachment. As the member is dragged on, the fascia and its 
point of attachment experience the sensation. The cause_ of 
the Dain may be that a sentient member has had its sensation 
destroyed bv the disease, so that the weight is felt, but actual 
pain cannot' be felt any longer (e.g., cancer at the mouth of the 

stomach). . 

7. Incisive pain. This proceeds from a humour or sour 

quality. . - 

8. Irritant pain. This is produced by a certain type ot 
change in the humours (harshness, roughness). 

9. Itching pain. This is produced when a humour is acrid, 

sharp, or salt. . 

10. Pricking pain. The agent producing this is material 
similar to that which causes boring pain ; it is retained in an 
organ of similar type (to that which is the seat of boring pain) 
for a time and then ruptures it. 1 • • 

1 1 . Relaxing pain proceeds from matters accumulating in 
and stretching the belly of a muscle— not its tendon. It is only 
called relaxing if the belly of the muscle is more lax than the 
nerve, tendon, or enveloping membrane. 

12. Stabbing pain. This is the result of transverse 
stretching in membranes, as if their continuity were being 
separated, by a humour. It may be an equal or an mequal 
sensation. In the former case, all the members of the body are 
uniformly affected. In the latter case, there are four possibilities : 
(1) Inequality in hardness or softness between the tissue with 
which the membrane is covered and the membrane itself. Ex. : 
the clavicle or costal pleura ; in a case of inflammatory process 
travelling from the pleura towards the upper parts of the chest, 
the pain is felt in the collar-bone, (ii) Inequality of movement 
of the component parts (e.g., the diaphragm and the p eura or 
peritoneum over it), (iii) Inequality of nature between the parts 
and the member, (iv) Unequal distribution of nocument among 
the parts and the member affected, in that it affects one and not 

another. . . . c 

13. Tearing pain. Proceeds from the interposition ot 



THE CANON OF MEDICINE 251 

humour or gas between bone and periosteum, or from cold which 
strongly constricts the periosteum. 

14. Tension pain. This is produced by a humour or gas 
stretching the nerve-fibres or muscle fibres asunder. 

15. Throbbing pain. The cause is a hot inflammatory 
process. A cold inflammatory process, of whatever type, is either 
hard or soft, but sets up no pain unless it changes into a hot 
inflammation. Throbbing pain arises in a hot inflammatory 
process if the adjoining member is sentient, and has pulsating 
arteries round it. A member which is healthy does not sense 
their movement, because they are deeply situated, but their 
pulsation sets up pain as soon as an inflammation arises in the 
member. 

435. Agents which alleviate pain. There are three groups 
of agents which alleviate pain : (1) Some contrary to the cause of 
pain — which removes the cause. Ex. : anethum, linseed, made 
into a poultice and applied over the painful place. (2) Any 
agent which counteracts the acrimony of the humours, or soothes, 
induces sleep, or dulls or soothes the sensitive faculties and 
lessens their activity. Ex. : inebriants, milk, oil, aqua dulcis, 
etc. (3) An agent which infrigi dates and dulls the sensation in 
the painful part. Ex. : all narcotics and somniferous drugs. 
The first of the three is the most certain. 

This subject is referred to again at the end of Part IV. 

436. The effect of pain on the body. Pain dissipates the 
bodily strength and interferes with the normal functions of the 
organs. The respiratory organs are inhibited from drawing the 
air in, and consequently the act of breathing is interfered with, 
and the respiration becomes intermittent, or rapid, or altogether 
unnatural in rhythm. 

The organs are first made hot, then cold ; this is because 
some of the breath and vitality is dispersed and escapes. 

437. The causes of pleasurable sensations. The agents which 
produce pleasurable sensations fall into two groups. (1) Where 
an intemperament suddenly becomes equable and the senses 
become_ aware of the change. (2) Where there is a sudden 
restoration of the natural continuity. 

Sensation depends on sudden change, whether painful or 
pleasurable. Pleasurable sensation is to sense harmoniously ; 
and this act of sensation is performed by the sensitive faculties. 
It is a passive act. One experiences pleasure or pain according 
as the sensation is harmonious or disharmonious. The fact that 
the sense of touch is the most elementary (crude) of all these 



252 THE CANON OF MEDICINE 

senses accounts for it retaining the harmonious or disharmonious 
impress longer. When that which comes to the sense of touch 
is harmonious with nature, the pleasurable sensation is greater ; 
and if the agent is disharmonious, the painftd sensation is greater 
than would be the case with the other faculties. 

438. How movement brings on pain. Movement and 
exercise induce pain when nerves are stretched thereby, or when 
muscles become contused or lacerated thereby. 

439. How depraved humours evoke pain. Depraved 
humours" evoke pain either by reason of their qualities (for 
instance, acridity), or by reason of their being abundant (thereby 
stretching the fibres of a tissue of making the organ heavy) ; or 
for both reasons together. 

440. How gaseous substances produce pain. Accumulations 
of gas may become painful when they cause a part to be greatly 
distended. Gases may accumulate in (a) hollow viscera (e.g., m 
the stomach : gastrectasis) ; (b) the membranes over organs, or 
nerves (e.g., colicky pain from stretching of the nerves of the 
intestinal wall) ; (c) the sheaths of muscles, serous membranes, 
or periosteum ; (d) the subcutaneous tissues (the place between 
the muscles and the loose fascia or skin); (e) internal members 
(e.g., the muscles of the thorax). _ 

Gas may be dispersed rapidly, or only after a time. This 
depends on the amount, and whether coarse or fine, and whether 
the member itself is dense or rarefied in structure. 

27. Agents which bring about Retention or Discharge. 

441. It is easy to know the causes of retention or discharge 
if one ponders well over what has already been said about reten- 
tions and evacuations. The reader should therefore turn back 
and carefully re-read what has been written about it. 

28. The Causes of Over-Repletion (Plethora). 

Plethora.— ' Passive congestion " is over-repletion with blood ; it is associated 
with stasis.— " Active congestion" is the equivalent of waram, _ apostema. — 
Oedema is over-repletion with lymph (serous humour) ; it is associated with. stasis 
in the lymphatic channels or serous cavities. The practical result is that the chan- 
nels cannot drain or empty within the available time.— Hypertension is a form of 
plethora.— Corpulence is over-repletion with fat, namely in the connective-tissue 
spaces. One practical result of this is that supervening disease produces greater 
affliction than otherwise, as was written in the Charaka- (i. 236) .-Plethora of the 
connective tissue spaces with a mucoid change m the fluid may produce the appear- 
ance of obesity. This peculiar change is met with in the female sex ; it fluctuates 
in degree from time to time, and may appear or disappear within a few days. 

Intestinal stasis is over-repietion of the large intestine. -,,+,,+ 

It' may be noted that the effect of stasis anywhere is to interfere with that 



THE CANON OF MEDICINE 253 

flow of breath which is essential to health, or even life. The breath is " choked " 
or " strangled." The faculties are also at a disadvantage, for their free operation 
is conditional on free flow of breath through aU parts of the body —In modern 
terms, oxidative processes are retarded or arrested. 

442. The causes are extrinsic and intrinsic. 

1. Extrinsic (primitive), (a) A dietary (fluids as well as 
solids) which gives rise to much moisture beyond the heeds of the 
body ; matter accumulates in the body, and interferes with the 
action of the emunctories. (3) Taking baths frequently, especially 
after meals, (c) Repose ; ceasing to take exercise ; ceasing to 
secure the usual evacuations. These prevent the resolution of 
material in the body, (d) Improprieties in eating and drinking ; 
depraved regimen. 

2 . Intrinsic, (i) Lack of digestive power, so that the aliments 
are not completely utilized, (ii) Feebleness of expulsive faculty, 
(iii) Undue vigour of retentive faculty, so that humours are 
caused to linger in the body, (iv) Narrowing of the excretory 
channels. 

29. The Causes of Asthenia and Debility of a Member. 

443. Weakness may affect (i) the body of the member 
itself ; (ii) the breath, which conveys power to it ; (iii) the faculty 
of the member. 

(i) The following produce weakness in the member itself : 
{a) A persisting intemperament, especially a cold one. 
For even though the member receive some heat, the cold in- 
temperament produces an effect like stupor in it, because it 
breaks up the temperament of the breath— just as happens when 
a person stays too long in the bath, and especially when such a 
procedure brings on syncope. A dry intemperament has an 
inspissating effect, and acts by preventing the faculties from 
functioning in the member. A moist intemperament relaxes and 
obstructs. 

(b) One or other of the composite diseases. 

(c) The most important in all-in man) is neither nocument, 
nor malady, nor pain. It is an attenuation of texture in the peri- 
pheral nerve-fibres of the member, for both vegetative and 
voluntary actions depend for their achievement on° these fibres 
in all their ramifications. The retentive power which is necessary 
to secure efficient digestion depends on the condition of these 
fibres in the stomach. 

(ii) Weakness of the breath itself. This will occur if it be of 
bad temperament. There may also be dissipation of the breath, 



254 THE CANON OF MEDICINE 

after an evacuation corresponding. It is also weakened by an 
abnormal mode of depletipn. 

(iii) Weakness of the faculty. This depends on the number 
of actions and the number of times they are repeated. The breath 
is dispersed at the same time. Moreover loss of breath accom- 
panies every agent which produces asthenia. 

444. The causes of asthenia may be classified in another 
way, so as to include the remote causes with them — the causes 
of causes. We then consider (i) causes of intemperament ; 
(ii) causes arising from decomposition changes in the air, in 
water, and in the aliment • (iii) causes which cause the breath to 
escape, or become confused, or, as it were, shaken up. Nothing 
disturbs the breath, or causes it to escape as effectively as does a 
bad smell, such as the fetor from putrid water, or the presence 
of poisonous vapours in the air, or in the body. [Under such 
circumstances, the instinctive action is immediately to " hold the 
breath."] 

445. Evacuations as a cause of weakness. For instance, loss 
of blood ; diarrhoea, especially of thin attenuated fluid ; the 
sudden withdrawal of copious dropsical effusions by paracentesis ; 
the opening of a large abscess with sudden- withdrawal of much 
pus — whether the opening is by nature or by surgical inter- 
ference ; excessive sweating ; severe exercise. 

446. Severe fain disperses the breath and may alter its 
temperament. The chief kind of pain likely to have this effect is 
that from distension, or incisive pain — especially in the pit of 
the stomach. Any pain in the region of the heart will disperse 
the breath. 

447. Fevers should also be included among the causes of 
asthenia. They act either by dispersing the breath, or by loss of 
blood, or through producing a change of temperament. 

448. Widening of the pores often aids in producing 
asthenia. Long continued semi-starvation has the same effect. 

449. Weakness in one member or in a part of a member 
may cause weakness of the whole body, as is seen in the case of 
defective function of the cardiac orifice of the stomach, which 
produces general weakness of the body. Or, if a person suffers 
severely from some cardiac or cerebral trouble, shortness of 
breath rapidly supervenes on very slight provocation. 

450. Further, a cause of weakness may be that one has 
endured many illnesses. 

451. When one member is weaker than another from 
birth, or when it is by nature weaker in itself (e.g., the lung, or 



THE CANON OF MEDICINE 



2 55 



brain), then it is receptive for matters which the stronger mem- 
bers reject or discard, or eliminate. The brain would suffer in 
this way were it not for its position, whereby nothing comes to it 
which it cannot tolerate, even its virtues cannot persist there. 



END OF THESIS II. 




C. Retributive or Expiative Causes of Disease. 

§ 201. The idea that illnesses were a form of " judgment " or 
punishment, or retribution for misdeeds, was formerly widespread, 
but is not regarded seriously in modern Medicine. In the case of all 
peoples who hold the Buddhist belief in karma, this ancient idea 
holds_ good because every event, good or bad, in the individual life 
is believed to be the outcome of events in a past life — whether in this 
particular existence or in a previous incarnation. Wherever the 
theosophical teachings hold, the same view would be held. Moreover, 
in Islam there is no difficulty in the idea because " there is no second 
cause," and as is written in the Mesnavi, in speaking of Izrail, the 
angel of death, God is said to " operate by disease and sickness, and 
men will not look for any cause beyond these diseases " — in virtue of 
the truth of text (Quran 56, 84) " He is nearer to you than ye are ; 
yet ye see Him not." 

Ghazzali, in his " Alchemy of Happiness " says : "illness is, so to speak, a 
cord of love by which God draws to Himself the saints concerning whom He has 
said, ' I was sick and ye visited Me not.' Illness itself is one of those forms of 
experience by which man arrives at the knowledge of God. As He says ' sick- 
nesses themselves are My servants, and are attached to My chosen.' " 

During mediaeval Christian times pandemics were regarded as 
the manifestations of divine wrath, and the incidence of illnesses is 
sometimes still explained in similar terms in modern Christianity, the 
microbic and other tangible causes of disease being taken simply as 
the instruments whereby the event is achieved. (Cf. § 113.) 

As in the case of the idea of " fate " and " destiny," the subject 
is apt to be viewed incorrectly. Illnesses are sometimes evident 
warnings ; sometimes they belong to the category of expiation, 
whether in relation to others or to the victim himself. In any case, 
diseases may be regarded as in some way connected with that 
experience of life which the sufferer has himself to undergo. In 
Thomistic terms, such would be the " final cause " of disease. 

In the life of Saint Lydwine of Shiedam, 124 we read how a cele- 
brated physician, Godfried de Haga, endorsed and deferred to " the 
divine law that every malady is an expiation ; that if God does not 



256 THE CANON OF MEDICINE 

regard the expiation as satisfied, the course of the illness cannot be 
altered by the art of medicine. Cure cannot result from his treatment 
unless his intervention coincides with the completion of the expiation 
which has been imposed on the patient by his Lord." * 

In modern times this belief is manifested as a conviction in the 
pastoral instructions to the Catholic medical man that he is not 
entitled to continue his ^ministrations on a patient gravely ill unless 
his (Catholic) patient has fulfilled his spiritual duties within a certain 
number of days of the onset of the severe symptoms. 

"Hay muchos decretos eclesiasticos que prohiben a los medicos 
visitar mes de tres veces, si el enfermo no se ha confesado." — • 
(Vilariho, 142, p. 645.) _ 

The following advice to the patient himself is less narsn to 
appearance : " first when thou feelest any indisposition, accept it 
as a dispensation of the love of My Heart. . . . Afterwards, unite 
thy sufferings with Mine. ... If thy infirmity increases offer to 
Me thy body as a living victim. ..." (Arnold, xvi) 

This teaching leaves no room for doubt about the true answer 
to the oft-aired question, " should the doctor tell ? " (his patient that 
his illness is likely to prove mortal). 



* It was subsequent to the named physician's life-time that Paracelsus wrote the 
words actually quoted, adding " when the time for redemption has come, the patient 
will then find the physician through whom God will send him relief." Paracelsus 
classified the causes of disease under five headings : those arising in morbid states 
of the body ; those belonging to the category of poisons (intoxications) ; those 
arising from " astral " origins ; spiritual causes (passions, disordered thoughts, 
morbid imagination) ; and retributive. = 8 a (p. 199, 221). 




THESIS III. THE EVIDENCES OF DISEASE 

i. General Remarks about Symptoms and Signs 

" The science of the diagnosis of disease by internal symptoms is founded upon 
six canons : (i) the patient's actions, (2) the waste of the body, (3) the nature of the 
pain, (4) the site of the pain, (5) swelling, (6) the effluvia given off by his person." — 
Night 45 1." 1 

" A physician who is a man of understanding looketh into the state of the body 
and is guided, by the feel of the hands, according as they are firm or flabby, hot or 
cool, moist or dry." — Night 450. 




452. 

Y means of the symptoms and signs of the three 
main states of the body (health, illness, neutrality), 
we obtain information as to the present, the past 
and the future of the patient's state. Knowledge 
of his present state, says Galen, is of advantage 
to the patient alone, showing him what he must 
do ; knowledge of the past is advantageous to 
the physician alone, as proving him to excel in 
his art, so that his advice becomes worthy of respect (because 
reliable) ; knowledge of the future serves both purposes — it 
is advantageous to the patient because it guides him along the 
road he should follow, and it is advantageous to the physician 
in showing him to excel in his art. 

The signs belonging to the first category are called " demon- 
strative " ; those of the second category are " commemorative " ; 
those of the third are named " prognostic." 

453. The signs of health, (i) Those which denote an 
equable temperament. These are referred to in 494. (2) Those 
which denote equability of the composite : (a) substantial : 
creaturely form, position, quantity, number ; (F) accidental :. 
comeliness, beauty ; (c) final : (i) that is, fulfilling functions ^ 
(ii) fulfilled function. 

Every organ is healthy whose functions are adequately 
performed. 

257 S 



258 THE CANON OF MEDICINE 

The evidences that the functional state of the principal organs 
is adequate is shown by, studying their activities. Thus the 
state of the brain is shown by the state of the voluntary power 
of movement, by the state of the sense-organs, by the acts of 
judgment ; the state of the heart by pulse and respiration ; the 
state -of the liver by the character of the excreta and urine. 
(If the urine appear like the washings of fresh meat it shows that 
there is deficient liver-function.) 

454. The signs of disease. i Some signs are pathognomonic 
of disease — thus : rapid pulse-rate, in fever, itself indicates 
fever. 2 Other signs indicate the position of the disease. Thus 
a hard pulse denotes diaphragmatic pleurisy ; undulant pulse 
denotes inflammation ' in the substance of the lung. 3 Other 
signs indicate the cause of the disease. For instance, the signs of 
plethora, or of depraved states in their various forms. 

4. Some symptoms are essential to the illness, as they begin 
and end with it. (For instance, acute fever, piercing pain, 
dyspnoea, cough and serrine pulse— essential to pleurisy.) 
Other symptoms show no time-relation of this kind ; they some- 
times coincide with the disease and sometimes not (e.g. headache 
in fever). Other symptoms appear only towards the close of the 
illness — as for instance, the symptoms of crisis, of maturation, 
of delayed maturation ; the signs of death. These symptoms 
are often associated rather with acute illnesses. 

5. Other symptoms concern the state of the members. 
Some of them are discernible by the special senses — colour, 
hardness, softness, heat, cold, and the like. Others are dis- 
cernible by all senses together — the form of the member, its 
position (posture, attitude), its size, its movements, or stillness. 
Some symptoms point to an interior state, as when tremor of the 
lower lip reveals nausea. Changes in measure and number 
reveal internal states ; for instance, shortness of fingers denotes 
small liver. 

' 6. Morbid states are discernible by the special senses. Thus 
a black or yellow colour of the excrement reveals a morbid state. 
Black or yellow jaundice of the whole body reveals an obstruction 
in the biliary passages. 

7. States manifested to the sense of hearing. — Eructations 
reveal gastrectasis, and defective digestive power. 

' 8. Odours and tastes also enable one to become cognisant 
of morbid states. 

9. Other visible evidences ; curved nails denote ulceration 



THE CANON OF MEDICINE 259 

in the bronchi, phthisis and " hectic." Redness of the cheek- 
bones suggests inflammatory deposit in the lung. 

455. 10. Movements (gestures, postures, attitudes'). — The 
states of the body are revealed by its movements, or absence of 
movement. (i) Motionlessness of the body as a whole — in 
apoplexy,- epilepsy (coma), syncope, palsy. (2) Unusual move- 
ments : shivering," tremor, twitching, sneezing, yawning, 
stretching, cough, trembling, spasms (especially note in which 
member this begins) ; (i) some of these are physiological 
(hiccough) ; (ii) others are symptomatic (convulsion or spasm, 
tremor) ; (iii) some are voluntary (tossing about in bed ; turning 
from side to side) ; (iv) others are partly voluntary, partly involun- 
tary (cough, micturition, defecation) ; in some of these the 
voluntary is overruled by the involuntary (cough), while in others 
the voluntary overrules the involuntary (micturition and defeca- 
tion, occurring too slowly owing to interference by the will) ; 
(v) involuntary movements. Some of these are evident to the 
senses (e.g. shivering), others are not (e.g. quivering, jactitation). 
These movements vary (a) in regard to their nature ; thus, 
cough is intrinsically more energetic and powerful than quiver- 
ing; (/?) in extent : thus, the act of sneezing entails the use of 
more muscles than the act of coughing does ; coughing is 
accomplished simply by the movements of the chest, sneezing 
entails movements of the head as well as of the chest; (y) in 
degree of associated mental anxiety. Dry hiccough is associated 
with a greater degree of mental anxiety than the movement of 
coughing, though the latter is more vigorous, being reinforced 
by the natural faculty. In some cases the movement is aided by 
an essential primary instrument ; thus, defecation is aided by the 
abdominal muscles ; in other cases the aid is extraneous : thus, 
the natural act of coughing may be aided by the atmosphere; 
( s ) in origin. These movements vary (a) according to the member 
(cough, nausea) ; (b) according to the faculties involved (jacti- 
tation originates in the vegetative faculties ; the act of coughing 
originates in the sensitive faculties) ; (c) according to the humour 
concerned (thus, cough proceeds from an excretion ; twitching 
from a gaseous agent). 

These are all evidences of conditions in the members and 
are chiefly external in character. Some of them reveal internal 
conditions ; as, for instance, redness of the cheeks is a sign of 
pulmonary inflammation. 

There are also (internal) evidences of external conditions, 
and to discern these a perfect anatomical knowledge is necessary. 



2 6o THE CANON OF MEDICINE 

456. One must have a proper knowledge of : — 

(i) the essential structure of each member ; whether fleshy 
or not ; what is its normal form. One must know (a) whether 
the swelling for instance is according to the proper form of the 
member or not; {b) whether it is proportioned or not; (c) 
whether- it is possible for anything to be retained within the 
given member or not; (d) whether that which is within (e.g. 
jejunum) can escape; (<?) whether there can be retention in 
and also' escape from the member ; (/ ) what the material is 
which can be retained in it or discharged from it. 

(ii) Its site. From this one judges whether pain or swelling 
is actually in the part or at some distance from it. 

(iii) Its relations. By this knowledge one judges whether 
pain is arising per se or reflexly from the surroundings, or whether 
the matter in an inflammatory mass arose in it or has entered 
into it from neighbouring parts. If it be a " superfluity " which 
escapes, is this the matter itself or is the affected member merely 
the channel by which the matter finds egress from the body ? 

(iv) How to decide whether the discharge could have come 
from the supposedly affected member or not. 

(v) The normal function of a member. — From inter- 
ference with function one recognizes' the diseased state. 

This is the purpose of the study of anatomy. And a knowledge 
of anatomy is also necessary to enable the doctor to control 
diseases involving the interior organs. 

457. The study of the significance of the symptoms of 
internal diseases should follow the following six headings : 

i. Interference with function. The functions have already 
been described in regard to their qualities and degrees. The 
indications here are primary and constant. 

2. The discharges. The indications here are constant but 
not primary. They are constant in that they are always associated 
with morbid states. They are not primary because they denote 
maturation, or interference with maturation. 



These are neither primary, nor 
constant. 



3 . Pain 

4. Swelling 
$ . Altered p osition 
6. Special symptoms 
458. Details about these headings. 

1 . Interference with function. When a function does not 
proceed normally, it shows that the agent at work is attacking the 
faculty itself, and the loss of function is secondary to disease of 



THE CANON OF MEDICINE 261 

the organ subserving that function. There are three ways in 
which function is interfered with : {a) impairment (e.g. failing 
eyesight, near sight, digestion impaired in rate or degree) ; (b) 
alteration (as when the eye sees that which is not there or per- 
ceives incorrectly ; when the stomach digests food wrongly 
and causes it to decompose) ; (c) destruction (as when there is 
entire loss of vision; entire loss of digestive power). 

2. Significance of discharges and retentions. 

A. Retention of that which is normally discharged : 
retention of urine or feces. 

B. Abnormal discharge : 

(i) From the substance of a member 

(a) itself diagnostic : Ex. : when a piece of 
cartilaginous tissue is coughed up ; this is a 
proof of deep ulceration in the air-passages ; 

(b) diagnostic by reason of its dimensions or 
amount : passage of flakes in dysentery ; if 
they are large flakes, the ulcer is in the large 
intestine ; if fine fragments, the ulceration is 
in the small intestine ; 

(c) colour of the discharge. If urinary sediment 
is red, it shows the disease is in the fleshy 
organs such a.s the kidney ; if white it shows 
the disease is in a muscular organ like the 
bladder. 

(ii) Not from the substance of a member : 

{a) entirely unnatural. Thus healthy humours 
or blood should not be discharged at all ; 

(b) abnormal in quality. Thus depraved blood 
may be discharged physiologically, or not ; 

(c) abnormal in substance ; e.g. calculus ; 

00 abnormal in quantity : e.g. polyuria, oliguria, 

excess of fecal discharge, paucity of feces : 

(a) abnormal in quality : black feces, 

black urine ; 
(/?) discharge by unsuitable or unnatural 
channels : e.g. passage of feces by 
the mouth in cases of strangulated 
hernia. 

3. Significance of pain. 

{a) Its site : If right-sided, examine the liver ; if left-sided 
the spleen. ' 



262 THE CANON OF MEDICINE 

(b) Its type, which reveals its cause (see 434 ; ^ancLthe 
doctrine of causes). Severe pain indicates inflammation in a 
non-essential member, or in a member which has lost sensation, 
but has become greatly, distended by foreign matter. Incisive 
pain shows that the diseased material is sharp, acid or acrid. 

4... Significance in regard to inflammations. 

{a) As to essence : erysipelatous inflammation denotes 
bilious humour; " scirrhus " (induration) denotes atrabilious 
humour. 

(b) As to position : whether on the right side or the left 

(liver, or spleen). 

(c) As to shape : a moon-shaped swelling in the right 
hypochondrium points to the liver ; an elongated swelling 
refers one to the overlying muscles (rectus and adnexa). 

5. Significance of site and relations. 

The site may be self-evident. The relations vary in sig- 
nificance according to the morbific agent. Thus a lesion in 
the fingers may result from injury to the brachial plexus in the 

neck. 

6. Significance of special symptoms : e.g. of wasting, of 
black tongue, burning fever. 

Joannitius gives a rather different classification of symptoms and signs, 
though summarizing from the same text. It may be said that every classification 
is a matter of personal convenience. There is not necessarily any principle involved, 
for the subject comprises so great a variety that a strictly logical classification serves 
no special purpose. In some cases symptoms are characteristic of a cause, m others 
of an error of function, in others of a special disease. To adhere consistently to one 
rule of classification necessarily entails the relegation of some symptoms which are 
important in actual practice to a. subsidiary or insignificant position in the list. 

Hence it may be said that Avicenna's classification will hold gcod as well as 
any. The student obtains his knowledge from his own experience, and not from 
memorizing a given list. 

§ 202 . The following list of simple ailments, or evidences of disease, may 
be offered at this point. 8 5 , . . . 

Pain. — The first evidence of disease or ill-health. Its localization is very signi- 
ficant, and charts depicting its possible sites and their meaning are of great use. 
Thus,' headache is very commonly simply a sign of indigestion (gastric or intestinal) 
or constipation. The type of pain is most important. Thus pain in the abdomen, 
relieved by pressure, suggests gaseous distension due to abnormal fermentation of 
food, whereas pain increased by pressure suggests inflammation. 

Abnormal discharges. — Abnormal in quantity (increased or diminished), such 
as diarrhoea, polyuria ; abnormal in quality, such as nose-bleeding, hemoptysis, 
expectoration, nasal discharge, salivation ; abnormal in manner, such as incontinence. 

Abnormal acts. — Vomiting, Coughing, Hiccough, Eructations, Yawning, 
Sighing, Shivering, Sleepiness, Insomnia, Altered gait, Altered posture (from palsy, 
exhaustion, collapse), Tremors, Twitchings, Convulsions, etc. 

A bnormal subjective sensations. — In special senses : floating specks before the 
eyes in dyspepsia ; ringing in the ears in cases of nervous debility, or after certain 
drugs, or from wax ; bitter taste in dyspepsia ; dizziness arising from nerve derange- 
ment,' or circulatory errors. In general : nausea, palpitation, throbbing, laboured 
breathing ; altered appetite, thirst ; sense of lassitude or asthenia ; irritability ; 
loss of memory. . 

Outward signs. — Discoloured or " heavy " eyes. Offensive breath m indi- 
gestion and constipation. Wasting or obesity. Hot and dry skin in fevers, or 



THE CANON OF MEDICINE 263 

states of mental excitement, or from excess of salt in the diet. Cold sweating from 

exhaustion, etc. Altered colour of skin. CEdema of skin. Skin-eruptions. • 

Signs derived from examination of the mouth : Pale tongue and gums from blood- 
deficiency ; bleeding gums from excess of- salt in diet and other causes ; coloured 
line on gums in metallic poisonings ; coated tongue in digestive disturbances ; 
loosened teeth from errors of diet, or the use of adulterated foods, etc. 

2. The Distinction between the Disease in itself and its 

Secondary Effects 

459. Diseases may affect a member primarily, or only 
secondarily. Thus, a disease of the stomach may become associ- 
ated with one in the head. Hence it is necessary to distinguish 
between the two conditions, as being respectively primary and 
secondary. To do this, note which arises first, and then note 
which of the two morbid conditions persists. The former is 
judged to be primary; the one which develops later is considered 
to be secondary. Conversely, the disease is secondary which 
comes after the first, and ceases when the first is relieved. 

460. Errors may arise, however, because a primary disease 
may escape the senses (being painless) at first, and its effect may 
not become manifest till after the secondary disease has appeared. 
Moreover the primary disease may not be able to be perceived 
until after the secondary one has developed, and so one is liable 
to regard the secondary one as primary, and overlook the real 
root of the disease. 

461. To guard against this mistake, the physician must 
know the anatomical inter-relations of the organs, and also the 
several affections which each member may show. Some of these 
are evident to our senses, others are not. He must also avoid 
giving a definite diagnosis of the root of the disease until he has 
had time to consider the possibility of some of the states being 
secondary or not. 

462. Therefore the physician will diligently question the 
patient in order to discover signs indicative of the various affec-" 
tions which can possibly occur secondarily in the neighbouring 
or related organs. If these are not painful (tender), the patient 
is unaware of them, and the various signs and symptoms may be 
only distantly related in his mind. He cannot know the relation 
between remote symptoms and the real root of the disease. The 
wisdom of the physician alone can determine this. 

483. It is easier if one recalls the various points to memory 
under the heading of hindrances to function. If these are prior 
in time, the malady is secondary. 

464. Some affections of organs are usually secondary to 



2 6 4 THE CANON OF MEDICINE 

others. Thus an affection of the head is usually secondary to 
one or other of the morbid states of the stomach. The converse 
is only very rarely true. 

All the signs of the primary and secondary temperaments 
will be set forth in a general way now, leaving the signs of each 
special .organ to its appropriate place. The visible signs of a 
composite disease are detected by the senses, but the internal 
symptoms of the body as a whole cannot be described in a general 
way except with difficulty— with the exception of the signs of 
plethora, of obstructions in passages, of inflammatory masses, 
and of loss of continuity. It is best to describe all these together 
when we describe them under their specific organs. 

3. The Diagnostic Signs of the Temperaments. 

465. Signs from which the variety of the temperament is 
discernible. — These can be arranged under ten groups. 

I. the feel of the patient 

By means of the touch one notes whether the feel of the 
patient corresponds to health in temperate climes and temperate 
atmosphere. If it corresponds, the temperament is equable. 
If the physician is himself healthy in temperament and finds the 
patient cold or hot, softer or harder or rougher than normal, 
and this is not to be explained by the state of the atmosphere or 
of a previous cold water bath, or some other contingency render- 
ing the body soft or rough, though normal— he then knows the 
finding is due to an intemperament. 

466. The state of the finger-nails should be noticed. 
Softness or dryness of the nails, not due to an extraneous agent, 
informs one of the state of the temperament. These qualities 
are not in themselves a sufficient criterion. There must be signs 
of balance between heat and cold. For (a) heat, by its resolving 
effect, would modify hardness and roughness of feel, and make 
the patient seem to be attempered and his nature seem soft and 
moist. Or, (b) cold — i.e. the opposite — by reason of the great 
congelation and inspissation it induces, would make the softness 
of feel in an attempered person seem hard, and give the im- 
pression that his nature was dry. For instance, take snow and 
the sun. Snow congeals and causes coagulation ; the sun causes 
aggregation of particles. Many persons with a cold, tempera- 
ment are soft to the feel, and also spare in habit owing to the 
presence of much crudity in them. 



THE CANON OF MEDICINE 265 

II. THE STATE OF THE MUSCLES, FLESH AND FAT 

467. Plentiful muscular development denotes moist tem- 
perament, and warm temperament if the muscles are firm. 
Scanty muscular development with very little fat shows that the 
temperament is dry. Oiliness and fat always denote cold tem- 
perament, and the muscles are then also flabby. 

If at the same time there is constriction of the veins and lack 
of blood, and if there is weakness from lack of food (because 
there is too little blood to enable it to furnish the requirements 
of the tissues), this shows that this temperament is inborn and 
habitual. But if these other signs are absent, it shows the 
temperament to be an acquired one. 

488. Lessening of the amount of oil and fat in the sub- 
cutaneous tissues always indicates a hot temperament, because 
the substance of oil and fat is the oiliness of the blood, and that 
is derived from cold. Hence these things are less plentiful in 
the liver-region, and more plentiful over the intestines. There is 
not more oil and fat over the heart than over the liver, except 
as to matter ; it is not temperament or " form " which ac- 
counts for this ; it is simply that the " nature " of the heart 
depends for its maintenance on the presence of such-like 
" matter." 

Congelation of oil and fat over the body is greater or less 
according as the heat is more or less in degree. 

If the body is fleshy, and the amount of fat and oil not 
great, the temperament is hot and moist. 

If the body is very muscular, and there is much oil, but 
little fat, this denotes excessively humid temperament. If ex- 
tremely^ fleshy, this denotes superfluity of moisture and cold. 
It is evidence that the body has become cold and moist. 

469. The more spare the body is in habit, the more likely 
is it to be cold and dry ; or (less likely) hot and dry ; or, dry, 
for such a body is attempered as to heat and cold. Or, hot, 
because such a body is attempered as to moisture and dryness. 

III. THE HAIR 

The points to note are : rate of growth ; amount ; fine- 
ness or coarseness of texture, straightness or curliness, colour. 

470. Rate of growth. Slow growth, or absence of growth, 
without evidence of lack of blood — denotes extremely humid 
temperament. More rapid growth denotes a. less humid tem- 
perament, rather tending to dryness. (Heat and coldness of 



266 



THE CANON OF MEDICINE 



temperament are shown by other signs — given above — than the 
hair.) ; 

If the temperament is both "hot and dry the hair grows much 
more rapidly, and the individual hairs are numerous and coarse. 
Abundance of hair means heat, coarseness much fumosity. 
Hence the hair is more plentiful in youthful persons than at 
puberty, as the humours of the latter are vaporose, not fumose. 

The opposite characters denote the respective contraries. 

471. Form of the hair. Curly hair : denotes hot and dry 
temperament. It may be that there is tortuosity of the minute 
channels and pores : and this cannot change even if the tempera- 
ment changes. But the two primary causes would change if 
the temperament changed. Straight hair denotes cold and moist 
temperament. 

472. Colour of the hair. 



Colour 



Black. 

Brown. 
Tawny and red. 



Very fair. 
Grey. 



Corresponding 
temperament. 



Hot. 

Cold. 
Equable. 



Cold and 
very moist. 
Cold and 
very dry. 



Remarks. 



In such cases oxidative processes are in 
excess of the mean (Joannitius). 



There is an excess of " unburnt heat," so 
that the hairs always grow red (J). 
Hence the proneness to anger (a form of 
" heat "). 

Note how plants lose their dark or green 
colour when dried, and become grey or 
white. In man, this change is produced 
towards the close of desiccant diseases. 



473. Cause of grey hair. Aristotle stated that hair turns 
grey because it takes on the colour of serous humour. (Joan- 
nitius ascribed it to decomposition changes in the serous humour 
occurring in old age ; greyness, he says, means excess of atra- 
bilious humour.) Galen ascribed it to a mustiness accompanying 
the nutriment supplied to the hair, which retards its movement 
and penetration into the pores (of the hair) (i.e. hair-sac). 

As a matter of fact there is little difference between the 
two views, because the whiteness of the serous humour is 
physically due to the same cause as the whiteness of the mustiness. 
The subject really belongs to physics. 

474. Observation also shows that atmosphere and geo- 
graphical situation affects the hair. One would not expect to 
find the hair red (which denotes equable temperament) in a 



THE CANON OF MEDICINE 



267 



black person even though his temperament were equable ; nor 
would one expect to find black hair (which denotes hot tempera- 
ment) in a Slav, even though his temperament were hot. 

475. Relation of character of the hair to the age. In puberty 
the hair is as in northern countries ; in youth, as in southerly- 
countries ; after the age of fifty it is between the two. Abund- 
ance of the hair at puberty reveals the future temperament. As 
the person grows, it precedes the formation of atrabilious humour, 
and in the elderly person it shows that atrabilious humour is 
actually present. 



IV. THE COLOUR OF THE BODY 



476. Colour. 



Pallor. 

Yellowish. 

Ruddiness. 

Sub-ruddiness. 



Dark Brown. 



Brown. 

Colour of Egg- 
plant fruit* 
Chalky. 

Leaden. 



Grey and white. 
Ivory White. 



Temperament. 



Cold. 

Hot. 

Hot. 

Hot. 



Extremely 
cold. 



Hot. 

Cold and 
dry. 
Cold. 

Cold and 
moist. 



Cold. 
Cold. 



Accompanying features. 



Lack of blood. 

Lack of blood ; increase of bilious humour. 

Abundance of blood ; sanguine or bilious 
temperament. 

Dominance of bilious humour. Occasionally 
it denotes lack of blood, provided there is 
no bilious humour present in the blood, 
as is the case in convalescents. 

This is because sanguineous humour is 
dominant, and there is deficient coagul- 
ability of the blood and it darkens and 
alters the colour of the skin at the same 
time [Joannitius ascribed blackness to the 
atrabilious humour]. 

The heat is such as follows upon pure atra- 
bilious humour. 

Serous humour in excess (J. ascribes white- 
ness to the serous humour). 

Atrabilious humour is only slightly in excess. 
This is because there is a trace of green in 
the whiteness ; the latter depends on the 
serous humour and moistness of tempera- 
ment. The greenness depends on con- 
gelative change in the blood, for this tends 
to a blackness which, mingled with serous 
humour, produces a greenish tint. 

Serous humour in excess, and the choleric 
humour scanty. 



477. Co/our of the eyes. 

It is not easy, but it is possible, to assess the temperament 
of the brain from the colour of the eyes. 

* Egg-plant ; brinjall ; solanum melongena, or black brinjall. The colour 
is a purple-black. The fruit is referred to as a colour in Night 357 : " a flabbv 
nose like a bnnjall " (Burton). " The vegetable is held to be exceedingly heating 
and thereby to breed melancholia and madness " (ib ). 



268 THE CANON OF MEDICINE 

The following details are from Joannitius : 
Black : due to : smallness.. of crystalline lens ; setting of the 

crystalline lens too far back ; ^abundance of aqueous humour ; 

turbidity thereof; uvea redundant; peculiarity of the visible 

" breath " (scanty, or confused). 
Brown : due to the contraries of the above — crystalline lens large 

or further forward ; paucity of albugineous humour ; clearness 

of this ; deficient quality of uvea ; the visible breath plentiful 

or clear. 
Intermediate colours (black and brown mixed). The visible breath 

varies in amount and clarity. 
Grey : visible breath less plentiful. 

478. Changes of Colour 

Change to yellow (yellowish-white) : suspect disorder of 
the liver. 

Change to yellowish-black : suspect disorder of the spleen. 

Change to yellowish-green : suspect piles (this does not 
always hold good (marginal reading). These suggestions only 
apply for the moment when the change of colour takes place. 

479. Colour of the Tongue 

It is not easy to assess the temperament of the stomach and 
intestines and veins from the colour of the tongue, any more 
than it is to assess the temperament of the brain from the colour 
of the eyes. 

There may be two different colours simultaneously in two 
members, in consequence of a disease. Thus, the tongue may 
become white and the countenance dusky. This occurs in 
jaundice, when this is due to an intense acridity of the bilious 
humour. 

480. Extraneous causes of Colour Change 

Cold climate (e.g. in Scotchmen), hot climate (e.g. negroes). 
Emotional changes : fear, rage, sadness, etc. 

V. THE FORM OF THE MEMBERS 

481. Hot temperament : big broad chest ; large limbs ; 
no narrowing or shortening of the hands or feet ; conspicuous 
full veins.; big strong pulse ; the muscles round the joints large 
(for growth and the form of composite structures requires heat). 

Cold temperament : the contraries of aU the above. The 
natural faculties and the formative faculty are impaired by cold, 
so that the natural functions are not perfectly carried out. 



T 



THE CANON OF MEDICINE 2 6 9 

Dry temperament : roughness, curvature of form ; joints 
conspicuous. Adam's apple prominent. Nasal cartilages con- 
spicuous ; nose of medium size. 

Moist temperament : the contraries. 

Joarmitius adds: fleshiness (excess of heat and moisture in the tem- 
perament) •;■ Fatness (excess of moisture and intense coldness); Leanness (hot 
temperament, and mtense dryness) ; Delicate build-cold and very dry • Massive 

balan^d humours^ 7 m ° 1St ' ^ ^^ C ° ld ^ Very m ° iSt ; J ustness of form— well- 
VI. RAPIDITY WITH WHICH MEMBERS RESPOND TO HEAT AND COLD 

482. If a member becomes " hot " rapidly and easily, 
it shows that it is hot in temperament, because change in the 
direction of its own temperament is more readily undergone 
than m the opposite direction. Similarly, if the member behaves 
in the contrary way, it will be of cold temperament. 

483. Some assert that it is otherwise, because we know 
(they say) that a thing only reacts to its contrary and not to its 
like. But if that were the case, it would follow that a thing would 
react more strongly to its like. But the reply to this is that two 
things are only really alike when one does not interact with the 
other; we then know that their respective qualities are of like 
" species " and " nature." Of two things A and B, if B is 
less hot than A, we cannot speak of it as being " like A." As 
long as one of the two is hotter, they cannot be called ""alike." 
One is cold compared with the other. So an interaction (on the 
part of the body) is possible. B would be cold compared with A 
— not hot. B, too, may react with something else which is colder 
than itself [say C] besides reacting with " cold " [say D]. C or 
D may enhance the intrinsic quality of B, according as they are 
stronger than B or not. It is easier for it to change towards that 
which enhances this quality of B, or neutralizes the opposite 
quality of B, on condition that the new causative agent harmonizes 
with A and B, and neutralizes the temperamental nature (p). 

Therefore it is clear that when the nature is of hot tempera- 
ment heat will not show any action on it until the influence of 
the contrary cold has first been removed ; and this is achieved 
by preventing the calefaction (which tends to be produced by a 
hot temperament) from becoming greater. The result is that 
if both events occur simultaneously, and the inhibiting agent is 
destroyed, they will mutually help one another in producing 
heat, and the two qualities will thus reach an acme. 

When the body is exposed to foreign heat, however, the 
balance of temperament is likely to be destroyed. The innate 



a 7 o THE CANON OF MEDICINE 

heat of the body is all-important for resisting this We depend 
on our innate heat for the neutralization of " hot_ poisons, and 
for their expulsion and for the dissolution of their substance. 

484 The innate heat, therefore, is the instrument ot 
(human)'" nature " for combating the injurious action of extra- 
neous or foreign heat. By its means, the breath gets rid of it, 
expels it, disperses it, and oxidizes its material basis (m). further, 
it combats the injurious action of foreign cold, expelling it 
" by contrary." Coldness has not this power. It is only the 
contrary to coldness— i.e. foreign heat— which can combat or 
repress it. Coldness cannot combat extraneous cold. ine 

innate; heat does. 

485 Innate heat is that which protects the natural humours 
from being overruled by foreign calorific agents. If the innate 
heat is strong, the natural faculties are able to work through it 
upon the humours, and so effect digestion and maturation, and 
so maintain them within the confines of the healthy state. The 
humours move according to its ministration. Extraneous or 
foreign " heat " cannot interfere with this movement and so 
they do not undergo putrefactive decomposition. If the innate 
heat is feeble, the natural faculties are harassed m the regulation 
of the humours. For the instrument— the intermediary between 
the natural faculties and the humours— is enfeebled. Stagnation 
sets in and foreign heat now finds the humours no longer opposed 
to its action. It overcomes them. It utilizes them m its own 
way, and imparts a foreign movement to them ; and the result 
is what is known as " putrefaction." _ , 

486 Hence it is clear that the innate heat is the instrument 
of all the faculties, whereas coldness can only help them second- 
arily That is why one speaks of " innate heat, but not ot 
" innate cold " ; and why that which is proportionate to heat 
is not comparable with cold. 

S 2 o3 This passage is evidently an attempt to explain the nature of bacterial 

The following may be amplified accordingly . 
i The meaning of innate heat. 
2 The nature of " foreign heat, foreign cold. 
■x The meaning of the term " hot poisons 

a The meaning of hot and cold, as relative terms. .-,,,„ 

ti) JnnatThel^ This term, particularly m ^J^'^£"£^ 

<• -^\;L' Th^ word describes a complex concept. Though regarded as vague 

known and freely-accepted data belong to it. material 

(2) The nature of " foreign heat Joreigncoia. xuc =! ., substa nce 



THE CANON OF MEDICINE 271 

stance, which as we know undergoes lysis in the course of the immunising processes 
of the body. The " heat " refers to what we know as the bacterial toxins which 
act upon the thermogenic centres, and produce numerous other effects oh the 
tissues. The word "heat" thus comprises two things. The pyrexia produced 
by bacterial invasion may be theoretically distinguished from the innate heat, but 
practically speaking the rise of temperature is generally admitted to be part of the 
so-called defensive mechanism against infections. The destruction of the bacteria, 
and of their products by anti-substances — these events are comprised in the words 
" dispersing the foreign heat." After all, both bacteria and products are " dis- 
persed." We are only being told the same fact in different language. 

In the case of foreign cold, here the organisms and products differ. But if 
the temperature becomes subnormal, the immunizing process is not ascribed to the 
lowered temperature. Recovery from the infection still depends on the " innate 
heat " or " vitality " — that is, a series of processes of immunization which take 
place whether the patient develops fever or not. 

Avicenna considers that the formation of septic products is more likely if there 
is not much pyrexia, on the ground that in such a case the bacteria, as we should say, 
meet with less resistance, and are enabled to produce those decompositions of the 
body fluids which we know to take place readily as soon as the vitality of a part 
is lowered. 

(3) The meaning of the term " hot poisons." Clearly the word poison must be 
understood as covering both bacterial agents and their products. The toxic products 
may produce rise of temperature, and are therefore reasonably called " hot " ; 
others do not have this effect. 

(4) The meaning of hot and cold, as relative terms. In this passage a thing is 
hot or cold according to its effect on the bodily sensations, or its effect on the heat 
centres of the body. Taken in its literal or surface meaning, of hot temperature, 
cold temperature, the passage is of course pedantic and useless. It should be evident 
that the words " hot " and " cold " cannot possibly have meant literal heat and 
cold. 

VII. SIGNS DERIVED FROM SLEEP AND WAKEFULNESS 

The sensitive faculties make use of these things frequently, 
in a manner corresponding to the primary qualities. Thus we 
say that in the wakeful state the body is the instrument of the 
soul. 

487. If there is equipoise between sleep and wakefulness, 
it means that the temperament (especially of the brain) is equable. 
If sleep dominates, it denotes a cold and moist temperament 
(of the brain), whereas if wakefulness dominates, it shows a dry 
and hot temperament (especially in the brain). 

A strong inclination to sleep denotes debility — a loss of tone of the muscular 
power. Histologically, sleep depends on a break in the ideation-zone of the cerebral 
cortex ; if there is a break in the layer below that, the sleep will be that of stupor 
or coma. The break in this situation is marked in amentia and dementia. — Wake- 
fulness, or insomnia, denotes : poisons circulating in the blood, powerful sensory 
impulses (pain), or powerful emotions. 

VIII. SIGNS DERIVED FROM THE STATE OF THE FUNCTIONS* 

488. Equable temperament : the activities of the body 
proceed fully and perfectly and naturally. 

Hot temperament : there is over-activity, exaggerated 

* Functions may be weakened, exalted, depraved, obstructed in their action 
or abolished. 



272 THE CANON OF MEDICINE 

activity. Rapid growth of stature ; increased rate of growth 
of hair ; early eruption of the teeth. 

Cold temperament : the activities lessen and become sluggish 
and delayed, but a hot temperament may cause weak and sluggish 
activity though only if a deviation from the natural course is 
associated with weakness. 

489. Many natural functions may slow down or lessen 
owing to heat. Thus in the case of sleep, sometimes there is 
insomnia or lack of sleep from the effect of the heat of a hot 
temperament. Similarly some of the natural states may be 
intensified by cold. Thus, again, in the case of sleep, though this 
is not strictly the outcome of natural functions, but only an effect 
conditional upon some causal agent. For the necessity for 
sleep for life and health is not absolute ; (a) it enables the breath 
to separate off from its impeding factors — the fatigue-substances; 
(b) there is need for a recumbent posture after a meal ; (c) one 
cannot achieve two (contrary) things at the same time. _ Hence 
the need for sleep is simply some impotency. It is not included 
in " natural necessity." And if its exclusion be " natural " in 
the sense that it is inevitable, this is only because the word " natu- 
ral " is here used for " the inevitable." One word is being made 
stand for two things. But the most accurate application of the 
term is to " equable temperament," for it is this upon which 
equability of functions and their final completion depends. 
To use the term in regard to the four qualities — heat, coldness, 
dryness, moisture— is only hypothetical (takhminl). 

490. Among the " strong " (" jelal ") actions which denote 
a hot temperament are : powerful voice ; harsh or coarse 
voice ; rapid way of talking ; constantly talking ; anger ; 
rapid gestures ; blinking of the eyelids. Before deducing a 
hot temperament from these, one must make sure there is no 
local cause for them, and that they are not confined to one 
particular member. 

IX. SIGNS DERIVED FROM THE EXPULSIVE FACULTY AND FROM THE 
QUALITY OF DISCHARGES 

491. The temperament is hot : (i) if the waste matters 
are retained ; (2) if the faeces, urine, sweat, etc., are strong in 
odour, acrid, of normal colour, and show the normal degree of 
oxidation and maceration — in the case of matters which normally 
undergo such changes. 

If the signs are contrary, the temperament is cold. 



THE CANON OF MEDICINE 



273 



X. SIGNS DERIVED' FROM THE STATES OF THE MIND, DURING 

ACTION AND PASSION 

" Every expression is the sign of a state of mind ; that state is as the hand, 
and the expression is the instrument." — (Mesnavi, 5S p. 29). 



492. - • Evidence. 


Name of Temperament corresponding. 




Hot. 


Dry. 




1 

Concupiscible 2 

3 


— (Shameless) * 
Excitable 
Lively 
Vivacious 


Infatuation ; love- 
passion. 


aspect 


1 

Irascible 2 

3 

Duration 


Hopefulness 
Courage ; temerity J 
Easily provoked to 

anger 
Short 


Brooding 

Anger lasts some time 

Long* 




Intellectual power 


Good 


Imaginative 


Mental 
capacity 


Power of observa- 
tion 


Good 


— 




Capability 
Talent 


Good 
Conspicuous 


Memory good 


Moral aspects 


Stern 

Virility of morals and 

manners 
Diligence 
Much flexibility of 

opinionj 


Gentle 


Ego faculty 


Love of good opinion 
Not easily perturbed 
or downcast 


Takes things to heart 


Movements and gestures 


Rapid 




Dreams 


Of warming oneself at 
a fire ; sitting in the 
hot sunf 





Cold temperaments show the opposites to those given for 
hot temperaments ; moist, the opposites to those given for dry. 

The whole of the above, or at any rate the major part of it, 
refers to the congenital or innate temperament. Now we refer 
to acquired temperaments (" intemperaments "). 

* In the case of the moist temperament, the duration of emotional disturbance 
is short. 

f In the case of a cold temperament, the dreams are of being in the cold, out 
in the snow, or of being immersed in cold water. 

In short, the character of the visual images in the dream is related to the char- 
acter of the dominant humour, partly because the dream varies with the state of the 
" breath " at the time. 

% These represent negative or weak aspects. 

T 



274 



THE CANON OF MEDICINE 



493. EVIDENCES OF THE 


FOUR PRIMARY INTEMPERAMENTS 


Evidence. 


Hot. 


-Cold. 


Moist.* 


Dry. 


Morbid states to 
which there is a 
tendency 


Inflammatory 
conditions be- 
coming febrile. 

Loss of vigour. 


Fevers related 
to the serous 
humour. 

Rheumatism. 


Lassitude. 




Functional 
Power 


Deficient energy. 


Deficient diges- 
tive power. 


Difficult 
digestion. 


— 


Subjective 
sensations. 


Bitter taste in 

mouth. 
Excessive thirst. 
Sense of burning 

at cardiac orifice. 


Lack of desire 
for fluids. 


Mucoid saliva- 
tion. 

Sleepiness. 


/ Insomnia. 
\ Wakefulness 


Physical signs. 


Pulse extremely 
quick and fre- 
quent ; approach- 
ing the (weak) 
type met with in 
lassitude. 


Flaccid joints. 


Diarrhoea 
Swollen 
eyelids 


Rough skin. 
Spare habit 

(acquired not 

inborn) . 


Foods and 


Calefacients are 
all harmful. 


Infrigidants are 
all harmful. 


Moist articles 
of diet are 
harmful. 


Dry regimen 
harmful. 


medicines. 


Infrigidants 
benefit. 


Calefacients 
benefit. 




Humectants 
benefit, f 


Relation to 
weather 
(i.e., season). 


Worse in summer. 


Worse in winter. 




Bad in autumn 



4. The Evidences of Equable Temperament 

(i.e., the evidences of symmetry, beauty of form, and good conformation.) 

494. In addition to the signs of normal temperament 
already given, there are : 

1. To the feel, the body imparts sensations mean between 
hotness, coldness, dryness, moisture, softness, hardness. 

The skin feels moist and warm, and has a beautiful smooth and elastic surface. 
The complexion is clear. 

2. In colour, the body shows a balance between whiteness 
and redness. 

3. In build, the body is neither bulky nor spare, though 
on the whole inclined to be bulky. (Robust Habit of Body. 7 ) 
Tallness and straightness of stature ; quick growth. 

4. The veins of the skin are neither prominent nor sub- 
merged ; they are separated and spread. 

* The signs of moist intemperament include those of the cold. 
f Hot water, rarefied oils are beneficial to the dry temperament and are 
avidly taken up. 



THE CANON OF MEDICINE 275. 

5. The hair is neither profuse nor sparse, thick nor thin, 
curly nor straight, black nor white. During puberty they tend 
to a tawny shade rather than 'black, in youth they tend to black- 
ness. [Full hair where hair should be.] 

6. Equally inclined for sleep and for wakefulness. 

Sleep quiet, uninterrupted, and followed, on waking, by cheerfulness, and a 
contented mind. 

7. Agreeable dreams arousing hopefulness, with fragrant 
perfumes and alluring voices, visions and agreeable com- 
panionship. 

8. Mental faculties : vigour of imagination, intellectual 
power, and memory. Emotions balanced between excess and 
deficiency — e.g., between courage and timidity, between anger 
and patience, between sternness and clemency, between vacilla- 
tion and perseverance. 

9. Perfection in all functions (185). 

Therefore no conscious feeling of digestion, or discomfort of any kind. 
Micturition painless, the urine not feeling hot, having an odour neither sweet nor 
sour, amber-coloured, and forming no deposit. Defecation without soiling the skin, 
the fasces firm, but not hard. — The appetite according to genuine hunger, and for 
natural foods ; thirst only for water. — Mouth closed when breathing. Adaptability 
to climate and to season (Ch. M.'). 

10. Movements of the limbs deft. (Skilful.) 

495. A person with such a temperament will have a happy 
expression, will be lovable and contented, moderate in desire 
for food and drink, possessing a good gastric digestion, good 
hepatic and venous digestion, and good alterative and assimila- 
tive power all through the tissues. The waste matters will be 
moderate in amount and will be -discharged through the proper 
channels. 

5. The Indications afforded by Congenital 
Mal-conformation of the Body. 

(i.e., asymmetry, misproportion, unshapeliness, ugliness, and the like.) 

496. In brief, there is non-uniformity of temperament 
among the members ; or, perchance, the principal members 
depart from equability and come to be of contrary temperament, 
one deviating towards one, another to its contrary. If the 
components of the body are out of proportion, it is unfortunate 
both for talent and reasoning power. Thus, (1) a tall person 
with a large abdomen and short face and round head, and short 
fingers' ; (2) a person of small stature, with small head, much 
flesh in the face and forehead, and even in the neck and feet — 
the face like the full-moon ; the jaws rounded and massive. 



276 THE CANON OF MEDICINE 

Similarly, (3). if the head and forehead were round, but the 
face very round (long, marginal reading), and the neck very 
thick, and if the eyes are sluggish in movement. Such persons 
would be the very last of people to be classed as in good health. 

6. The Signs of Plethora 

497. Regarding plethora there are two aspects. There is 
the plethora in regard to the cavities, tubes, and juice canals ; 
and there is the plethora in regard to power or strength (vitality). 

1 . Plethora of the channels of the body consists of an undue 
amount of humours or of breath. These may be healthy in 
quality, and merely superabundant in quantity, so that the 
channels are overdistended and overfilled. In such a _ case 
movements become dangerous, the vascular channels running a 
risk- of rupture, followed by a flux towards the regions where 
there is back-pressure, and choking of these parts may occur, 
with subsequent apoplexy or epilepsy. To relieve such, the 
local plethora must be rapidly relieved by venesection. 

2. Plethora of strength of faculties. In this case the error 
is not in quantity of humours, but in unhealthiness of quality, 
whereby the faculties are embarrassed, and they become inefficient 
for the processes of digestion and maturation. A person who 
is in this state is in danger of putrefactive disorders. 

498. Speaking in general the signs of plethora of the first 

type are : 

Objective : red face ; full veins ; tightness of skin ; 
sluggish movements (gestures) ; full pulse. High-coloured 
urine ; dense urine ; scanty appetite. 

Subjective : sense of weight in the limbs ; weak vision ; 
dreams in which there is a sense of weight — as when one dreams 
one is unable to move, or is carrying a heavy weight, or cannot 
give utterance to words. This kind of dream may be compared 
with that associated with attenuation of humours, or where the 
humours are moderate in amount for here one dreams one is 
flying through the air, or moving at a great speed. 

The modern term " hypertension" is covered by the old term of plethora or 
repletion. The correspondence is verified by some of its symptoms. Thus, hemor- 
rhagic phenomena occur — in the nose, retina, cerebrum, meninges, labyrinth, the 
skin ; and as hematuria and hsemetemesis simulating organic disease. Hyper- 
tension causes fatigue of the heart shown by : dyspnoea, palpitation, quick pulse, 
anginal attacks, nocturnal pseudo-asthma, bruit de galop 141 (p. 348). 

499, The signs of plethora in respect of faculties : Heaviness ; 
sluggishness; loss of appetite (these are also present in the pre- 
ceding type). Disinclination for exertion. Sense of burden- 
someness. 



THE CANON OF MEDICINE 



277 



If the plethora of. the faculty is unaccompanied by plethora 
of humours, the veins are not as distended, and the skin is not 
as tense, or the pulse as full and large, or the urine as gross 
(dense) or as red in colour. There is no lassitude except after 
undue movement and exercise and activity. The dreams consist 
of sensations of itching, stinging, burning, and of fetid odours. 
Which of the humours it is which is dominant in such cases 
is discerned by the signs which now follow. But in the case of 
plethora of faculty, illness ensues before all its signs are manifest. 

7. The Evidences which show which of the Humours 
500. is Dominant 



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278 THE CANON OF MEDICINE 

501. Additional remarks : 

The age of the patient gives a clue to the kind of humour 
likely to be dominant. 

Excess of sanguineous humour is shown by signs akin to 
those of plethora, and some of the signs given are accounted for 
by simple plethora. 

When the atrabilious humour is in excess, the blood is 
dusky and heavier than normal. Atrabilious humour is seldom 
in excess in pale and slight persons. 

One or two of the data given (under general physique ; on the hair ; the sur- 
face veins) are from Rhazes. 

Note the patient at rest (in repose) and in activity (gestures, attitude 
Note that the signs of his temperament are accentuated when he is ill. I lie 
type of reaction to infection is determined by his temperament. 



Signs of Obstruction (to the flow of the Humours) 
502. 

^M^^^S BSTRUCTION is known to be present if 
%r,rm£l?^m^^ there are s jg ns indicative of accumulation 
V of matters, and the patient experiences the 
I" sensation of fullness throughout the body 
-^ without there being any of the signs of 
general plethora. 

If the obstructions are in those channels 
through which much fluid is bound to flow, there is 
a feeling of weight or heaviness. Thus, in hepatic 
obstructions, the material from the aliments cannot enter the 
oro-an, and therefore accumulates and is retained, so as to 
produce a much greater "encumbrance" than an inflammatory 
swelling would. The difference from the latter consists in the 
great heaviness and the absence of fever. 

Obstructions in other channels do not lead to such a 
sensation of heaviness, but only one of overfullness and of 
stretching and tenseness. 

503. Obstruction in venous channels causes the skin to 
become tinged with yellow, since the blood does not then gain 
access to the surface (layers of the skin). 

The subject of " obstructions " is capable of great expansion. 

(i) The symptoms differ : — 

(a) With each of the humours. Thus, serous humour obstruction is manifested 



THE CANON OF MEDICINE 2?9 

as cedema of the glottis oedema of the lung, nasopharyngeal hypersecretion oedema 
of the kidney tissue, of the blood itself ; vomiting, diarrhoea, headache (too much 
cerebrospinal fluid), convulsions ; delirium, coma, Cheyne-Stokes respiration 
amaurosis. ■ - r ■ > 

(b) With the different substances. Thus in nephritis, obstruction of the 
channels in the skin prevents the wastes leaving the body by that route, with conse- 
quent manifestation as arthritis, anginas, otitis, etc. 

(c) _ With the atom groups. Thus obstruction to the outlet of nitrogen 
(azotaemia) manifests as hypertension, vomiting, diarrhoea, sialorrhcea stomatitis 
parotitis, retinitis, anaemia, of plasmatic type ; arthralgia ; fibrillar tremors ; coma : 
loss of appetite for meats. 

Viewing diseases in this way, the important thing is to find both site of obstruc- 
tion, and substance or atom-groups concerned. 

(ii) The symptoms may be monosyndromic or polysyndromic (Vallerv- 
Kadot, 1 " p. 296-299.) \ j 

(iii) Obstruction to the flow of " breath." 
x ^ ( iv ).J he "pores" which may become obstructed vary in size from that 
of the orifices of the body down to the smallest channels, whether visible to the 
naked eye or only with the microscope, or whether sub-microscopic or " ultra- 
microscopic. The pores vary in shape and consistence, resilience, elasticity dis- 
tensibility. Fluids may traverse them in both directions, but when there is ob- 
struction, they may be able to pass only in one direction or not at all. 

9. The Signs of Gaseous Distension 
504. _ Gaseous distension is recognized (1) by means of 
pain experienced in the sentient members. This is because the 
gasos produce a severance of continuity in the tissue-elements ; 

(2) by the movements which take place in the sentient members • 

(3) by sound ; (4) by touch. 

1. The pain of stretching is a sign of gaseous distension, 
especially if the painful tissues are soft to the touch. The evi- 
dence will be complete if the pain afterwards- ceases, for this 
could not occur without there being a loss of continuity. In 
members^ like bone or glandular tissues, gaseous distension is 
not manifested by pain, even if such distension arises in 
bones which have been fractured (unless the skin has been torn 
by the fractured ends). 

2. The movements which point to gaseous distension are : 
fidgeting, tossing about (peristalsis). They are produced by the 
gaseous materials making their way through the organs out of 
the body. 

3. Noises may be produced, e.g., gurglings, rumblings. 
These may be evoked by manual compression, percussing — as 
is done for distinguishing between dropsy (ascites) and tym- 
panites. 

4. Touch enables one to distinguish between distension 
with gas and other nodular swellings. Gaseous distension 
stretches the part and yields to pressure. That is not the case 
with fluid distension (liquid, viscous, mucoid). 

^ 505, The difference between inflation and gaseous dis- 
tension is not in substance but in form. The form or shape, 



2 8o THE CANON OF MEDICINE 

of the distended area is different when standing or lying down 
and manipulation will alter its position. 



10. 



The Evidences of Solid Swellings 



506 The presence of external tumours is easily demon- 
strated "to the sense of sight. Deeply placed inflammatory 
swellings are revealed by accompanying fever, as well as by a sense 
of heaviness, if the affected member be devoid of sensation, or of 
stabbing pain as well as heaviness if the member be sentient. 
Interference or hindrance to function and movement of a part 
affords a further sign of the presence of a " tumour." A certain 
degree of intumescence of the overlying part is a very important 
sign of an inflammatory mass, if sensation has access to it. 

Cold swellings are not accompanied by pain. 

507 It is difficult to describe the signs of tumours in a 
general manner. Even if one could do so it would be at the 
expense of wearisome words. That is why it is simpler to defer 
details to the special chapters. It will suffice for the present to 
say that wherever heaviness and not pam are perceived, and the 
signs of dominance of the serous humour are present, this leaves 
no doubt about the swelling being of pituitous nature. 

If there are signs of dominance of the atrabilious humour, 
and the swelling is hard to the touch, it will be an atrabilious mass, 
because induration is pre-eminent among the signs of this form 

of swelling. . 

508 Inflammatory swellings in muscular organs are 
extremely painful, and fever is intense ; the nerves are stretched 
early (causing the pain) and there is delirium. Such swellings 
interfere with the movements of contraction and expansion. 

509 Swellings in any of the inward parts of the body 
cause the abdominal wall to become wasted. If they are in- 
flammatory and undergo suppuration and track outwards, they 
cause extremely severe pain, with fever ; the tongue becomes 
very rough, and there is great wakefulness, and the symptoms 
become more and more severe— notably the sense of heaviness and 
weight and stiffness in the affected part. Induration and tension 
becSme evident. Sudden emaciation of the body, with hollow- 
ness of the eyes may develop. But when the process of sup- 
puration has attained maturity, fever is high, pam lessens, the 
pulse softens, throbbing subsides, and itching replaces the pam. 
If there was much redness and induration, the redness lessens, 
and the induration is less noticeable. Pressure on neighbouring 
organs lessens, and all the causes of pain subside, along with 



THE CANON OF MEDICINE 281 

the great sense of heaviness. When finally the abscess bursts 
there is a rigor (produced by the acridity of the sanious matter) ; 
fever increases again (because of the movement and discharge 
of the pus), and the pulse becomes " empty," unequal, weak, 
infrequent, small, broad, and slow. There is loss of appetite ; 
often the extremities grow warm. 

The pus may also be discharged through ordinary routes — 
the expectoration, the vomit, the urine, or the fasces. 

510. The following signs after the bursting of an abscess 
are good : subsiding fever, easy breathing, return of strength, 
quick evacuation of pus through its proper channels. 

511. Sometimes, however, in deep abscesses, pus passes 
from one member to another ; and this transference is sometimes 
beneficial, sometimes detrimental. It is beneficial when it passes 
from a principal member to a subordinate one ; as for instance, 
when it passes from the brain to the tissues behind the ears, and 
from the liver to the groins. It is detrimental if it passes from 
an ignoble organ to a noble one, or to a weaker or less resistant 
organ, as for instance when pleurisy involves the heart or 
lung. 

512. The passage of latent or hidden inflammation and 
abscesses and eruptions to higher or lower regions affords (dis- 
tinctive) signs. If they pass downwards, this is shown by difficult 
breathing and other respiratory trouble, and tightness of the 
chest. There is a burning sensation beginning below and passing 
to the upper parts. There is heaviness in the region of the 
clavicle ; and headache. Evidence may also be obtained from 
the clavicle and forearm. 

If it should pass upwards, and the brain become involved 
in inflammation, it is a bad and very grave sign. But if the 
inflammation passes into the loose tissues behind the ears, there 
is hope of recovery. 

Epistaxis is a good sign in such a case, as it is in all inflam- 
mations of the internal organs. 

A more careful account of all kinds of swelling will follow 
later, at the same time as we deal with the morbid states of the 
several internal organs. 

11. The Evidences of Loss of Continuity 

513. Loss of continuity in a visible member is readily 
evident to the senses. In the case of interior organs, loss of 
continuity is shown by 



282 



THE CANON OF MEDICINE 



(i) Pain — boring, stabbing, tearing. 

(2) Especially if there is no fever. 

(3) Often there is the flow of some humour — such as [a) 
hemoptysis ; (b) effusion into a roomy cavity of the body ; 
(c) outburst of purulent matter : in the cases where loss of con- 
tinuity-follows the maturation of an abscess, with bursting of 
the abscess. If the suppurative process has matured, the fever 
will subside and the pus be discharged, and the sensation of 
heaviness and pain will subside. Otherwise the pain would in- 
crease, and the other symptoms become more severe. 

(4) In some cases, loss of continuity is revealed by complete 
luxation of the member, or partial displacement from its proper 
position (e.g. hernia). . , 

(c) Diversion of discharges from normal to other channels, 
or into some cavitv, which has itself been produced by the break 
of continuity. Ex. : traumatic rupture of the intestines, whereby 
the fecal contents cease to leave the body; (false aneurysm). 

(6) In some cases, the existence of loss of continuity escapes 
detection by these general signs. Special signs peculiar to each 
member must then be utilized ; such as : loss of sensation; 
inability to retain the fluids normally entering the part; rigid or 
fixed position resulting from displacement of the part fromits 
proper position ; lack of rigidity ; inability to retain relation 
to another member from which it has become displaced. _ _ 

514 Prognosis. As you are aware, both loss of continuity 
and the "presence of (inflammatory swellings) are more grave 
when thev occur in very sensitive fibromuscular members. 
In fact, such loss of continuity may prove fatal from syncope 
or spasm. The syncope is due to the violence of the pain ; 
the spasms are due to the irritation of the nerves in which the 

parts are so rich. . . . 

Next in severity comes loss of continuity near joints, 
because restoration can only be slow considering the undue 
mobility of the parts, and the fact that spaces are opened up in 
and round the joints, and matters readily flow into these spaces. 

We now proceed to expound the subjects of the Pulse and 
the Urine, as affording general evidence of morbid states. 



THE PULSE 

"It is necessary to enquire diligently into the properties of the pulse for 
diagnosis and for the use of drugs." — Duhalde. 20 

" Every important variety of pulse revealed by the sphygmograph was re- 
cognized, described, and named, before the Christian era. ... We count the beats, 
and note their force and volume to ascertain the strength of the sufferer and the 
effect upon him of the disease. . . . Many of the indications obtained from the pulse 
do not depend on a knowledge of the circulation at all."* Broadbent, ".The Pulse " 
1890, p. 32. 

515.^ Definition. The pulse is a movement in the heart 
and arteries (the receptacles of the breath) which takes the form 
of alternate expansion and contraction, whereby the breath 
becomes subjected to the influence of the air inspired. 

In modern language, "it is the change of shape from the 
flattened condition impressed on the vessel by the finger which the 
artery assumes under the distending force of the blood within it, 
which constitutes for us the pulse." (Broadbent, ib. p. 20.) 

The subject of the pulse may be considered (i) generally, 
(ii) in regard to each of the several diseases. We defer the latter 
till abater period when we speak of the diseases themselves. 
At this stage we discuss the subject generally. 

516. Description. — Every beat of the pulse comprises 
two movements and two pauses. Thus, 

expansion : pause : contraction : pause. 

One movement could not pass at once into another in an 
opposite direction. There must be a boundary or " limit of an 
act," as is expounded in the work on natural science. 

Many doctors consider that it is impossible to perceive the 
movement of contraction. Others are able to perceive it — as 
" strength " — if the pulse is strong ; as " degree of expansion " 
in a large pulse, as " great resistance " in a hard pulse, and, in a 
slow pulse, by the long period of time occupied by the movement. 

Galen also says : " For many years I was doubtful about 
clearly discerning the movement of contraction by touch, and I 
shelved, the question until such time as I should learn enough to 
fill the gap in my knowledge. After that, the doors of the pulse 

* The following section on Sphygmology is therefore not obsolete, but of real 
value to the modern practitioner. 

283 



2 8 4 THE CANON OF MEDICINE 

were opened to me. Whoever should study these things as I 
did will perceive that which I perceived [as it were, a brilliant 
light shining suddenly out from behind total darkness. Whoever 
allows these words to be true and not fabulous will benefit very 
greatly ; despair will not touch him or frighten him from the 
pursuit of his study, even though he makes no progress for 
many years."] Nevertheless there are conditions in which this 
movement cannot be perceived. . 

517. Reason for feeling the pulse at the wrist. (i) it is 
readily accessible ; there is little flesh over it ; (2) the patient is 
not distressed by exposing this part. 

§ 204. This reason is important in the East where the doctor 
may not expose a female patient in any way. This interdiction 
accounts for the extraordinary erudition attained in the art of feeling 
the pulse, for instance in China. " The old Chinese doctors are 
remarkably good diagnosticians. Although the study of the patient 
is restricted to the examination of the two radial pulses, and noting 
the state of the eyes and tongue, the diagnosis is disconcertingly 
accurate." (Hartmann. 28 ) [( 

William of Rubruk, a Franciscan friar (1253) recorded : ihe 
Cathayans ... are first-rate artists in every kind, and their phy- 
sicians have a thorough knowledge of the virtues of herbs, and an 
admirable skill in diagnosis by the pulse " (quoted in Encycl. Brit., 
vi. 189, by Prof. Giles, who also states " the variations of the pulse 
have been classified and allocated with a minuteness hardly credible 

P ' 2 Eusebius Renaudot 148 (p. 209), in 1733, wrote : " They are so 
sure of the disease that they tell all the precedent symptoms to a 
nicety." 

(3) The artery runs in a straight course (which is no small 
help towards accuracy of diagnosis : Galen). 

(4) The distance from the heart is not great. 

§ 205 The heart and arteries all pulsate with the same rhythm, 
so that any artery can be used for feeling the pulse. But most arteries 
are embedded in flesh and cannot be distinctly felt. The order of 
clearness is : wrist, soles, behind ears, along arms. 

Arteries within bones cannot, of course be felt ; nor can arteries 
be made use of which have other bodies in front of them except m 
emaciated persons, where for instance the aorta or limb arteries 
become palpable for the first time. 

518. Technique in feeling the -pulse. (1) The position of the hand. 
If the palm be turned upwards the pulse will appear wider, less 
high and less long, especially in thin persons. If the hand be 
oalm down, the pulse seems higher, longer and narrower. 



THE CANON OF MEDICINE 285 

§ 206. (2) If the patient be a male, use the left hand : if a 
female, the right. 93 This ancient Chinese idea, that the pulse of 
one side has a different significance-to that of the other, is also met 
with, in a different form, in recent literature. Thus, Tones (see Bibl.) 
states that the pulse at the right wrist informs of the state of the con- 
stitution, or vitality, and that of the left wrist informs of the local 
disease, and the real and true condition of the patient. He further 
states that when both pulses are fully strong and regular, after an ill- 
ness, the patient is nearly well.— Baraduc, 110 on the basis of biometric 
observations of an elaborate kind, asserts that reactions obtained 
with the right hand belong to changes in the physical or material 
vitality of the body, whereas those obtained with the left hand belong 
to the psychic vitality.— These statements are of interest in relation 
to the ancient Chinese idea. 

(3) The position of the observer's hand.— This must be adapted 
according to the position of the patient. The middle finger must be- 
placed exactly at the junction of carpus with lower end of radius.. 
The other two fingers are now allowed to rest upon the artery, one 
on either side (ib.). The index finger should be nearest the heart.. 
(Broadbent, p. 39.) 

(4) Emotional state of the patient. The pulse should be felt 
at a time when the patient is not in a state of excitement or anger, 
or affected by exertion, or under the influence of the emotions, 
or in a state of satiety (which renders the pulse heavy), or of 
hunger ; nor must it be a time when usual habits are neglected 
or new ones are being formed. 

§ 2 °7- (5) The state of the observer. The observer must be in a 
calm state of mind. He must be very attentive and free from the 
least distraction of thought. The body must be tranquil, and the 
posture at ease. The respirations should thus be unimpeded and 
regular. His own state of health should be good (Duhalde. 20 ). 

Comparison with a normal pulse is thus possible. 

§ 208. (6) Other instructions given in the Chinese system of Sphyemoloey 
The instructions for feeling the pulse include the following : first apply the 
fingers gently, touching the skin very lightly at the three places corresponding to 
the three fingers— named C (for cubitus, or lower end of radius), G for " gate "and 
W (for wrist), the successive fingerpulps being in contact with those three places 
J. he character of the pulse is now noted in reference to the vital organs. 

s ! .M. Th f next ~ ep is to apply the fin g ers a little harder, but not hard enough to 
feel the bone. The attention should now be directed to the state of the pulse at G 
J. he third step consists m applying pressure till the bone can be felt, and then making 
tests with a view to deciding on the. state of each of the five main organs & 

If the wrist be long, the fingers need not be readjusted ; but if short readjust- 
ment of the fingers must be made several times, moving to juxtapositions each time 

J- he attention must not be allowed to wander from the search in question— 
the five vital organs and the six viscera. The sensation imparted to each finger is 
noted for the purpose. Great exactitude must be observed. The observation 
will evidently occupy a considerable period of time. 

" Fine though these distinctions are, the sedulous physician will perceive 
and remember them." 

A copy of one of the numerous diagrams in the work quoted is here appended 
substituting a translation for the actual accompanying text.* 

* For guidance in the translation of this passage and many parts of the work 
quoted, grateful thanks may be here expressed to Prof. J. P. Bruce and Mr. Li. 



286 



THE CANON OF MEDICINE 




^^Mj$r 



err; *|iie -hr* 



wp 



( Superficial pressure, to learn state from 
1 loin to ankle. 

*-Deep pressure : from heart to head. 
f Superficial : stomach, oesophagus. 
\Deep : spleen. 
( Superficial : chest. 
\ Deep : lungs to head. 



The left side is studied with reference 
to the state of the heart, small intestine, 
liver, bile, kidney. 

The right side, with reference to the 
lung, large intestine, spleen, stomach, 
generative system. 

1 Wrist : heart, small intestine. 
T ,, Gate : liver, bile. 
lJiit \ Cubit: (medium pressure) : kidney 
^ and bladder. 
I Wrist : lung, large intestine. 
_. ,. Gate : spleen, stomach. _ 

Rl 6 ht \ Cubit : heart and three vital 
^ centres. 
This is the classical and authoritative 
statement. 



w 



The following conditions are emphasized in this Chart : (i) It is 
summer : (2) the time-factor (including time of day) is 5, " j (3) J" 1 1S 
excessive at Ch'uan, small on the right side ; (4) Yang is small on the lelt 



o 



W 

W 
H 






a 
o 

en 

d 
a; 
W 

H 




side. The pulse corresponding to this is at the right " cubit " : full or 
heavy; fine or small ; and it is not responsive (to the " ether "). Another 
time-factor is 9, 5, 9, 11. 



o 

w 

K 
H 



" Q 
tn H 

H H 



Pa 
O 



H 
.J 



o 

<! 



THE CANON OF MEDICINE 



^7 



§ 209. Some noteworthy theoretical considerations arising out 
of the Chinese work may be added as applicable to the Arabian 
conceptions, without attempting to" outline their full system. 

We must study the subtler aspects of the nature of the human 
being by invading the domain of " occult " science (by some con- 
sidered to be forbidden), if we are to understand the real position not 
only of the great Chinese work, but also that of the Canon itself. 
With such a key, many of the passages acquire an entirely new aspect 
and value. The expansion and retraction of " the breath "• — so 
important in regard to the subject of the nature of the pulse, respira- 
tion and other periodic movements — are part and parcel with 
diurnal and other changes in what is called the " cosmic ether." 
By working out the formulae embodying' the behaviour of the human 
vibrations, using biometric methods, Baraduc 110 makes concrete that 
which is usually passed over as unauthenticated and apocryphal. 

The interpretation of the pulse depends on the interpretation of 
the body itself. The latter follows " world-conception " rather than 
concrete anatomy. The natural phenomena of the patient harmonize 
with those of nature in general, and the two must be taken con- 
jointly. 

According to the classical style — ■" the two ideas — ' urge,' 
' change ' — how important they are ! " They provide the key to 
physiological processes, and also to the understanding of the pulse. 
They represent something deeper than our modern idea " forces of 
Nature " ; they are over and above the ordinary course of Nature, as 
expressed in the Latin " praeternaturalis." These two ideas provide 
the purpose of study as the physician sits with his hand on the pulse, 
and his mind stilled for no small period of time.* The relation between 
the root factors of life and those of the patient is to be elucidated ; 
and they' find their expression in terms of functional activity of the 
several organs of the body. Hence this science of sphygmology pays 
regard to the seasonal variations, the age, the sex, the personal 
constitution, the dominant ' element,' its phase (rise or fall\ and 
especially the character of the vital force— active, passive, negative, 
positive (see Figure). It aims at forming an opinion as to whether 
the illness is slight or deep-seated, easily curable or incurable, fatal 
or not, and if fatal in how long a time. 

The permutations and combinations — the five tsang pulses, 
the six fu pulses, the seven pyau pulses, the eight li pulses and the 
nine tau pulses — all these afford ample scope towards a system which 
may encounter ridicule but is too rich in minutia; to be lightly put 
aside. 

For, quoting Broadbent again : " It is impossible to examine 
with attention a large number of pulses, whether among the healthy 
or the sick, without being struck by the extraordinary diversity of 
frequency, size, character, tension, and . force met with. This 
diversity prevails quite independently of disease in both sexes and 
with all ages, especially in regard to diameter of vessel and tension 

* See Frontispiece. 



2 88 THE CANON OF MEDICINE 

and force of pulse. . . . Taking everything into account, there must, 
when we compare the small, short compressible pulse of one man with 
the large, firm and long pulse -of another be great differences in the 
velocity and energv of the movement of blood through the capillaries 
in different individuals, and clearly there are great differences in the 
circulation of the same person at different times. . . . The fact that 
such differences are compatible with health and vigour is conclusive 
evidence that nutrition and functional efficiency, even of the nerve- 
centres, are not in such close relation with and intimate dependence 
upon the blood-supply as we are sometimes apt to suppose." 

The endless diversity in the pulse is not an incident, it is funda- 
mental ; the ancients sought to reduce it to a science because they 
frightlv) believed there was a law underlying this diversity. This 
goes with the fact that the various organs of the body actually vary 
greatly from the standards adopted by the pathological anatomist. 
The amount of blood discharged from the heart at each beat is very 
different in various persons. The state of health is as it were some- 
thing over and above the ordinary physiological mechanisms so fully 
expounded in modern textbooks. The attempt to reduce nutrition to 
mechanical laws is an attempt to bind to mechanics that which is 
beyond mechanics. 

Hence the studv of the Chinese system, and of their_ world- 
conception affords additional justification not only for contending that 
corporeal form, corporeal phenomena, and mental phenomena- 
features, contours, build, mannerisms, talents— all belong together and 
are mutually illuminative, but also for proceeding to the formulation 
of these associations and inter-relations. 

If in so doing, a Medicine is built up in which disease takes a very 
minor place, and " soil " (a rather tiresome, though expressive word) 
a first place, which it is the object of the physician to elucidate and 
continuously realize, It will at least be a guide to something approach- 
ing universality of application, and cease to attempt multi-specific 
therapy. 

S 210 The idea that different sensations can be imparted to adjoining fingers 
by one and the same pulse may be discussed briefly here. It must be assumed 
that there are potential waves of different lengths passing along the artery at the 
same time. Long waves reach one finger, but not another. The long sweep of an 
artery can actually be seen in thin subjects. The waves usually thought of are the 
short ones induced by the force of the impacts of the heart wall on the blood. Long 
tos consist of changes of tension in a spiral direction, and careful concentrative 
observation will allow such an accession to be felt _ . , 

S 2ii The relation between pulse and special organs is not to be regarded as 
fanciful when one obvious instance alone will justify it— the influence upon cardiac 
activity' and force of beat which the state of the stomach exerts _ 

8 212 The frequency of missed beats, and the number of misses compared 
with number of respirations, exemplifies another very widely neglected aspect of 

8*2 1^ The names given to pulses are of interest, but it is difficult to assign 
Chinese terms to particular Arabic or Latin names. It will suffice to present the 
following comparisons of pulse-types with natural objects, and human, actions 

Natural objects : Blade of small onion, solid within ; stone bullet shot out of a 
crossbow; drop of water ; down; drum-head; grate in a passage ; hole in a flute; 
filament of hair ; scattered leaves ; a pestle ; pills ; a silk thread ; the handle 
of a staff or spear ; untwisted string ; worn-out cloth. 



Table or Terminology 

A.^ — General Terms. 
(Arranged in pairs of opposites.) 



- 


Sec- 


ft . 

o ° 
O 


tion 

in 

trans. 


"(i) 


521 




522 


(2) 


523 


(3) 


524 


(4) 


525 


(5) 
(6) 
(7) 


526 
527 
528 


(?) 


529 


(9) 

(10) 


530 
533 



Term used. 



Long-Short 

Broad-Slender 

Deep-Elevated 

Large-Small 

Thick-Slender 

Strong-Weak 

Swift-Slow 
(Rapid-Sluggish) 
Hard-Soft 
(Compressible- 
Incompressible) 
Full-Empty 
Hot-Cold 

Hurried-Infrequent 
Brisk-Sluggish 
" Dense "-" Rare " 
Equal-Unequal 
(Regular-Irregular) 
Orderly-Disorderly 
Rhythmic- 

Arhythmic 



Term in Latin 
Text. 



Longus-Curtus 

Latus-Strictus 

Profundus-Elevatus 

Magnus-Parvus 

Grossus-Subtilis 

Fortis-Debilis 

Vehemens*-Imbecillus 

Validus*-Languidu.s 

Velox-Tardus 

Durus-Mollis 
Lenis* 

Plenus- Vacuus 

Calidus-frigidus 

Frequens-Rarus 

Continens-Resolutus 

Spissus f-Lassus 

Aequalis-Biversus 

Ordinatus-Inordinatus 
Pondus-arrythmus 



Term in Bulaq 
Text. 



Tawil'-qaslr* 

' arid "-day yiq' 

munkhaff ad 5 -mushrif • 

'azlm'-saghir 8 

ghaliz s -daqiq 10 

qawi'^-da'if 13 



sari' 1 '-bati' 1 * 
salb ' '-layyin x « 



mumtali' ' '-khali 1 • 
harr^-barid 30 
mutawatir * J -mutaf awut * ' 
mutadarik • '-mutakhalkhil * * 
mutakaflif * 5 -mutarakhi * •§ 
mustawi * '-ikhtilaf a * 
(mukhtaf) 
Muntazim "-mukhtalif so 
Wazn-arda'1-wazn s 1 



Term in 
Chinese Text.} 



ch'ang-tuan 

ch'eng-fu 
ta-hsiao 

li-jao 
hung 

k'uai-ch'ih 

shih-juan 
(Ke) 

man-kung (hsti) 

chieh(?)-huan(?) 

mi (chin)-san 
jun-k'ou 

ting-tai 



* Synonymous words occurring in older Latin editions. 

§ These synonyms all appear together in the one (Bulaq) text. 

t In the Latin the term " spissus " is often used as the opposite of " rarus. 
In the Arabic, the latter is mutafawut, to which mutawatir is opposite. In the 
passages in which spissus is used, the Arabic is often mutawatir and not mutakaSif. 
There is actually a slight difference between frequens and sdissus, for the former 
has the thought of an abrupt rise in the pulse-beat, according to group-number 2, 
whereas spissus conveys the idea of beats very close together. Rarus may be taken 
as the counterpart of either thought : if it means a leisurely rise, it is in accordance 
with group-number 3 ; if it means " spaced," this is also the idea m mutafawut. 
The Arabic distinguishes the two ideas of rarus, by using mutarakhi for sluggishness. 

The words rapid, hurried, brisk— slow, sluggish, leisurely, rare, and the words 
frequens, spissus, velox— rarus, tardus, languidus, are apt to be misleading, and it 
is difficult to avoid inconsistency, both in the Latin and the English, for m some 
cases one word conveys a better idea of a shade of- meaning, and in others another, 
whichever Arabic term is employed. 



'B. — Distinctive Terms. 
(Arranged alphabetically.) 



Term used- 



Section 

in 

trans. 



Bounding 

Chord-like 

Continuous 

Creeping 

Dicrotic 

Failing 

Flickering 



h Formicant 
i Harsh 



540, 571 
549 
538 

541, 572 

546, 560 

547, 568 

545 



k 
i 

m 
n 
o 

P 
1 



Intermittent 

Jerking 

Mouse-tail 

Recurrent 
Spasmodic 
Swooning 

Thrilling 
Wiry 



Synonym. 



Undulatory 

Unbroken 
Vermicular 

Fading, falling 

Recurrent 



Term in 
Latin Text. 



Term in 
Bulaq Text. 



542, 572 

543, 565 

538 
539 

544, 567 

538 
548, 569 
567, 600 

548, 570 

1548 



Serrate, 

sawing 
Interrupted 
Gazelle 
Decurtate 



Tense 
Recurrent 

mouse-tail 
Trembling 
Twisted 



Undosus, fluctuosus 
Chordosus 
Continuus 
Vermicularis 
Bispulsans ; dicrotus 
Cadens in medio 

Reciprocus ; mesalius 
pulsus inclinatus 
(Rhazes) 
pulsus innuens (Haly 

Abbas) 
Formicans 
Serrinus, serratus 

Intersectus 

Dorcadissans ; gazellans 
Cauda soricina ; murus 

innuens 
Reditivus 
Spasmosus 
Cauda reditiva 
Syncopizans 
Tremulus 
Retortus 



Al mawja* 18 
Mutawattir 35 
Muttasil" 
Aldudi 3 ' 
Dzuwa qar'aina' 
Al waqi' fi'l- 

wasat 37 
Musalli"§ 



Al namli" 
Minshariy 10 

Munqata' - ' 
Al ghazali 13 
Zanabul'l far' 3 

'aid 11 

Mutashannuj 4 5 
Ghashiya 16 . 



Hung (?) 
Hsien 



Wei 



Term in 

Chinese 

Text.J 



Murta'ish" 
Multawi 18 



Se 

Chan Hsieh 

Ts'u 

Fu 



Chin 

Fu, jao, tai (?) 

Tung (?) 
Hsi 



* Lit. a fast-going she-camel, whose girth slips through the inequality of the 
motion of the fore and hind feet. 

§ Lit. the third horse in a race. 

J Some of the Chinese equivalents here gi 
others are only approximately correct. This 
sphygmology is different, as indicated in §209. 
prove to be more exactly representative of the 
It is of interest that the " water-hammer pulse : 
(tan she, or yen tau), but does not appear to be 7 



given are free of ambiguity, whereas 

is because the basis of Chinese 

Dual terms also exist which may 

types given in part B of the Table. 

e " is described in the Chinese work 

: represented in the Qanun. 







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To face />age 289 



THE CANON OF MEDICINE 289 

Actions seen in nature : .a bird pecking; a bubbling spring; the branches 
of a willow tree in a gentle zephyr in spring ; drops of water dripping through a 
crack in the roof ; frisking fish ; f eathers ; agitated by the wind ; a bird flying low ; 
liquid being constantly gulped down ; rolling of thunder ; scattered leaves ; 
swimming on the surface of water ; the pace of a toad embarrassed by weeds ; water 
simmering in a kettle over a fire ; waves running into one another. 

Human actions : Throwing earth over an object ; going by stealth ; the 
strokes of a knife-point ; a knife scraping bamboo ; puffing and blowing in going 
upstairs ; turning back. 

§ 214. Ayurvedic Sphygmology . — Sarangadhara gives eight or nine verses 
showing how to examine the pulse, and gives the characteristics belonging to derange- 
ments of Vayu, Pitta and Kapha singly or in combinations. But this interesting 
subject is necessarily not dealt with here. 

519. Ten features in the pulse. We say that there are ten 
features in the pulse from which we are able to discern the 
states of the body. Some group them under only nine headings. 

(1) Amount of diastole ; estimated in terms of length, 
breadth, and thickness. 

(2) Quality of impact (lit. knocking at) imparted to the 
finger of the observer at each beat. 

(3) Duration of time occupied in each movement. 

(4) Consistence of the artery (resistance to the touch). 

(5) Emptiness or fullness of the vessel between the beats 
(modern : compressibility). 

(6) The feel — whether hot or cold. 

The remaining features concern several beats : 

(7) Duration of time occupied by the pauses. 

(8) Equality or inequality of force in successive beats. 

(9) Regularity or irregularity ; orderliness or disorderliness. 
Presence of intermissions. 

(10) Metre ; rhythm ; harmony ;' measure ; accent. 

§ 215. Additional points : frequency, or number of beats per minute ; number 
of beats to each respiratory movement (inspiration plus expiration ; mode of rise, 
mode of fall, and kind of pause at C.G. and W. as one tests from skin to bone and 
back ; the number of beats which occur before there is an intermission (an inter- 
mission is almost certain' to occur in everyone) ; the comparison of the patient's 
pulse with one's own, or with that of a person of definitely equable temperament ; 
the comparison of the pulse with that which should be present at a given season. 

DETAILS 

520. (1) Amount of Expansion. — The kind of -pulse in. 
terms of the three dimensions : length, breadth and thickness. 
There are nine variations in regard to one dimension alone, and 
these are called " simple," and there are nine compound varieties. 

§ 216. Broadbent remarks (" Pulse," 115 p. 7 footnote) that the^classificationof 
pulses according to length, breadth and thickness is superfluous. " Deserting the 
path of observation, Galen did not see that a cylindrical tube would expand equally 
in all directions, and that there could not be any difference between its breadth and 
depth. . . . The permutations and combinations of large, moderate and small pulses, 
to the number of 27 varieties of pulse — an over-refinement on purely theoretical or 
transcendental grounds, which led to extreme confusion." 

U 



290 THE CANON OF MEDICINE 

§ 217. A careful consideration of the text of the Canon, in conjunction 
with the Chinese writings, suggests that something more was in mind. One is 
dealing with waves, not with cylindrical tubes merely. There is a subtle distinction 
between breadth and thickness. Every tiny portion of an artery is fluctuating 
continuously both in health and disease in virtue of its vasomotor endowment ; 
and it is this that is sought. Here, as in so many matters in regard to the living 
being, the simple mechanistic conception leads to error (and to scepticism about the 
existence of unthought-of detail). It is possible in the physiological laboratory to 
reduce the (experimental) animal into something very nearly a mechanism, or 
actually into a mechanism, and in that way secure results which triumphantly 
prove the contentions offered ; but the living human being with the full possession 
of all his faculties constitutes a very different " proposition." Moreover, observa- 
tions on the more subtle vibrations, as by biometric study, go to suggest that there 
may be reason in the ideas in question (cf. Baraduc 110 ). 

521 o The simple pulses are : the long, the short and the 
mean ; the broad, the slender and the mean ; the deep, the 
elevated and the mean. 

The long pulse is one which is longer than normal. This 
is the type appropriate to a person of equable temperament or 
else approximating to this. The difference between the natural 
and the equable has been already made plain. ^ 

The short pulse is contrary to the preceding. 

The mean between these two extremes completes the first 

group of three. The remaining six can be understood on the 

same lines. 

Short pulse : Impact sudden ; acme momentary ; subsidence of wave abrupt, 
dicrotic wave present ; artery large ; tension low. 

Long pulse : Impact deliberate ; acme persisting ; subsidence of wave gradual ; 

artery contracted. 

Normal pulse : impact sudden, acme moderately high ; subsidence of wave 

gentle ; tension moderate. 

522. As regards the compound pulses, some have received 
distinctive names and some have not. A pulse which is increased 
both in length and breadth as well as in depth is called " large." 
When all these dimensions show diminution, it is a " small " 
pulse. The moderate pulse is the mean between these two. 

A small pulse may seem to be a large one in a wasted subject ; hence the pulse 
may be palpable in arteries in which it is not usually felt. The aorta may be felt. 
A pulse may seem small because carelessly felt in a person with a thick wrist. 

A pulse which is increased both in breadth and depth is 
called " thick " ; one which is diminished in these two dimen- 
sions is called " slender." The medium pulse is the mean 
between the two. 

523 (2) Quality of impact. The varieties are three : 
strong — this resists the finger during expansion ; weak' — the 
opposite character ; and the intermediate. 

Strong or violent pulse. — Impact strong ; acme high ; artery incompressible. 
Occurs temporarily in emotional states, or after the bath. It is habitual in persons 
of passionate nature (Aeg). 



THE CANON OF MEDICINE 291 

Weak or feeble pulse.— Impact faint ; acme low ; artery between beats is 
compressible. J 

524. (3) Duration of cycle. There are three variants : 
rapid or short or swift — where the movement is completed in a 
short space of time ; slow or sluggish or long — the contrary ; 
and the intermediate, or moderately quick pulse. 

525. (4) Consistence of artery. There are three variants: 
soft or easily compressible ; hard, firm or incompressible ; and 
one of moderate compressibility. 

526. (5) Fullness or emptiness. The full (high) pulse seems 
to be overfull of humour and gives the impression that it needs 
liberating. The empty (low) pulse is contrary in character. 
There is an intermediate' between the two. 

Empty pulse: the artery feels as if it contained bubbles of air, so that the 
Sflutf'T ° n an Smpty plaCe ( Ae S ineta )- (Chinese simile : "the hole in 

527. (6) The feel of the pulse. Hot, cold or intermediate. 

528. (7) Duration of pause. Hurried (" dense "), where 
the period between the two successive beats is short ; sluggish 
C' rare "), where the period is prolonged. And there is a mean. 
This period of time is recognized from the contraction-period, but 
if contraction cannot be perceived it is estimated from the 
period between two expansions. In this case it is reckoned 
from the times of the two extremes. 

529. (8) Equality or inequality. This is reckoned according 
as the successive pulses are similar or dissimilar, there being a 
difference of size (large or small), strength (strong or weak), 
swiftness_ (rapid or slow; prompter sluggish), hardness or soft- 
ness, until it happens that the second expansion of the first pulse 
is overtaken by the first of the next (due to excess of innate heat), 
or is weaker than the next (excess of weakness). 

If desired, one could expand this discourse and consider 
the equality or inequality in regard to the three variants in the 
other features of the pulse already named. But it is sufficient 
to consider them only in regard to strength. 

Regular (" equal ") pulse in the strict sense is one which 
is regular m all these respects ; if it is regular only in one feature, 
it is so specified. Thus we speak of a pulse as regular (" equal ") 
in strength or regular in speed. In the same way a pulse is irregu- 
lar either in all respects or only in one. 

Equal pulse : this is always regular 
OTlH ^ n , eC1Ual P ulse is n ° t altogether irregular. Supposing it to have no equality 
and yet to preserve a certain period, such, e.g., as to extent of diastole if there are 
two great and one small, then again two great and one small, and so on such a pudse 



2 92 THE CANON OF MEDICINE 

is unequal but regular. ■ If it not only had no equality, but also no order in its in- 
equality, such a pulse would be not only unequal, but also irregular. — So, too, with 
the other kinds. . 

" Not only may an inequality in the time of motion take place in regard to one 
pulsation in one part of an artery, but also in regard to the strength of the power ; 
not so, however, in regard to the extent of dilation (for it is impossible that the same 
pulse in the same place should be great and small at the same time), nor in regard 
to the other kinds of pulses. But in different places different parts of an artery 
may exhibit a double inequality in one pulsation. For the motion may continue 
constant, and be swifter- at one finger, and slower at another ; or it may intermit, 
and one finger may perceive it, and another not. And also, in regard to the extent 
of the diastole, the same inequality becomes apparent in different places." 

Irregular pulse. — Sometimes there is altogether an irregularity, observing no 
periods whatever. Sometimes there is regularity as to periods, but, having no 
continued order, they may in this respect be called irregular, but in so far as they 
observe a certain period regularly, they are regular as to their periods. E.g., two 
great, two small, three great, three small, and so on. (Aegineta, after Galen.) 

530. (9) Orderliness or disorderliness. There are two forms : 
the pulse may be irregularly orderly or irregularly disorderly. 
The orderly pulse maintains orderly succession. This occurs 
in one of two modes. The orderliness is absolute, where there 
is every feature maintained ; or cyclical, where there are^two or 
more irregularities which keep on repeating in cycles, as if there - 
were two cycles simultaneously, or superposed, so. that the 
original order reappears. 

In this way it becomes evident that the tenth feature belongs 
here, in a certain sense ; so that those who restrict the features 
to nine instead of ten are justified. 

531. For one must now see the musical character of the pulse. 
For in the art of music sounds are juxtaposed in orderly relations 
of loudness and softness which keep on repeating at regular 
intervals ; rates of utterance vary — some sounds coming close 
to one another, and others being further apart ; the attack 
may be abrupt or gentle, sharp or dull. The notes may be 
sounded clearly or be indefinite ; they may be strong or weak ; 
the volume may be full or " thin." The rhythm of the sequence 
of the sounds may be regular or irregular. 

In feeling the pulse, all these features are also to be met with. 
The intervals between the beats, or the successions, may be 
harmonious or inharmonious. So, too, the irregularities may be 
orderly or disorderly. It is orderly when there is a proper 
relation of strength and weakness. It is disorderly if there is not. 

All this belongs to the question of order and regularity. _ 

532, Galen indeed discussed the metre of the pulse, or its 
rhythm along the lines of musical nomenclature. Thus we would 
have double time, three-four time, common time, four-five time, 
five-six time, and so on. For those who have a sensitive touch 
and a keen sense of rhythm, with a training in the musical art, 



THE CANON OF MEDICINE 293 

such minutiae of observation could be correlated in the mind. 
I am surprised to think how many of such relations could be 
perceived by the sense of touchy and yet I am confident that it 
can be done if one is habituated to the use of it, and can apportion 
metre and beats of time. On the other hand, since these varia- 
tions all belong to inequality and disorderliness it is not necessary 
to define them particularly. 

The analogy between pulse and musical time is found in the Chinese work 
as well as in Avicenna. The fact that they compare certain beats with those pro- 
duced on particular musical (stringed) instruments shows that they had something 
in mind like that suggested above. The Kin pulse is so named after a musical 
instrument of that name ; another pulse is compared with the vibration of the 
thirteen stringed instrument named Tseng. 

533. (10.) Metre. Even if the preceding details cannot be 
perceived, at least the relation between period of expansion and 
period of pause can be appreciated, as well as the relation be- 
tween the total duration of beat and the total duration of pause. 
Under this heading, then, we place : first total period of pulse : 
next total period ; period of expansion : period of pause ; 
period of expansion plus period of pause : period of contraction 
plus period of pause ; period of expansion : period of contrac- 
tion. A relation of period of expansion : period of contraction ; 
or, period of first pause : period of second pause, is not important. 

534. Metre (rhythm, " beat," accent) is good (eurhythm) 
or bad (arhythm) according to the musical analogy. There are 
three kinds of arhythm : (i) pararhythm, where the beat is altered 
only slightly, and temporarily. Ex. : where the adult has a 
metre which is only natural in youth ; where a child shows a 
rhythm proper to an adult, (ii) Heterorhythm. This is a change 
greater in degree. Ex. : where a youth has a metre proper to 
an old man. (iii) Etrhythm. Here the change is to something 
altogether different, as where the metre does not conform to 
the human type at all. A great change of metre denotes great 
change of bodily state. 

§ 218 Relation between beats to musical time may be equally 
exemplified from Arabic poetry, for the richness of the poetic metres 
gives a simple and ample parallel. Cadences, pauses (corresponding 
to intermissions of beat) of various lengths produced by the words 
and phrases and intonations belonging to emotional expression 
being natural sequences with evident relations to physiological 
variations. A short passage of poetry may sometimes be sufficient 
basis for a correct impression of the whole, but it is better to ,hear 
the whole. So, in feeling the pulse, much may be learnt from 
the observation of the beats for a minute or two, and yet it is better to 
study a long series of beats in order to be sure there is no inter- 



294 THE CANON OF MEDICINE 

mission at all. This thought is applied in Chinese sphygmology . (See 

§ 22 9)- 

§ 219. Rhythmical successions of words — musical rhythm- — 

• — effects on emotional state and on physiological processes.- — The 
effect of words uttered in rhythm resembles that of musical suc- 
cessions of sounds. The different forms of rhythm which are 
adopted- in different kinds of poetry have each their own effect 
on the emotional state, and tend to produce in the brain all the 
concomitants of the emotional state which they themselves belong to. 
Therefore the reciter is able to produce specific effects on the minds 
of his hearers. For this reason, the idea of rhythm and cadence can 
be pursued both in Arabian poetry and in Arabian music ; and it can be 
pursued with respect to both aspects of aesthetics in any country or 
language, though some languages are more potent in their influence, 
according as they are intrinsically more, or less, musical. 

We may note that as the rhythm, whether of words or musical 
notes, evokes an influence on the pulse-rate in the course of their 
effect' on the ear itself — both internal ear and the ear of the mind- 
so the emotional effect will be produced even though the hearers are 
not purposely or specially receptive. This emotional effect may be 
inevitable, or it may be deliberate. To quote from numerous 
passages in the " Nights,"—" touched with it a masterly touch, at 
once exciting to sadness and changing sorrow to gladness . . . 
went on to sing ... to many and various modes, till our senses 
were bewitched, and the very room danced with excess of delight 
and surprise " (163) ; " meseemed the doors and the walls and all 
that was in the house answered and sang with him " (688) ; " played 
a measure which made all hearts yearn " (37) (Burton, ii. 291 ; 
iv. 322 ; i. 337). 

When the effect is deliberately sought, it is stronger the more 
thoroughly worked out the principle is — which explains why some 
composers meet with more response than others, and why some 
compositions are considered more perfect or attractive than others. 
Yet a great composer may still be in ignorance of why that par- 
ticular music should meet the need ; he may be guided by the 
effect which the thought of the particular music has on his ■ own 
organization ; or he may even work according to stereotyped lines 
elaborated by theoretical developments and studies, without having 
even " intuitive " feelings of his own. (Cf. Frederick Corder, 158 , 
p. 7). Music, the composer, the listener — all three show the same 
possible aspects : the purely artistic, the emotional, the scientific or 
intellectual ; and, more rarely, the inspirational and the celestial. 
The number of listeners whom he will attract depends on the type 
of music which the composer employs. In this way, for some 
the pleasure is in the stirring-up of desire to accompany the music 
with the bodily movements of various dances ; for others the pleasure 
is through the feelings ; for others it is through the intellect (e.g. 
the fugue) ; for others it is through some glimpse of the Abstract 
Truth which such music renders possible, even though they under- 
stand not what it is doing. But the last-named does not need 



THE CANON OF MEDICINE 295 

music in the ordinary, sense of the word (i.e., instrumental); it 
is that of which it has been said : " The music of God is everywhere 
for those whose hearts are open to -hear it." 

We may also note that it is not only the pulse-rate and the 
manner of the pulse beat which is influenced by the musical rhythm ; 
the effect pervades the body*, because all the vibrations which belong 
to the secretions and excretions, and to the nervous system throughout 
are affected, and tend to harmonize, each in their own way — -the 
successive waves becoming set so that all reach the same phase at 
some same moment which recurs every so often. The movements 
belonging, for instance, to the emergence of secretory granules from 
a salivary or peptic cell, or an adrenal cell, alter in rhythm during 
the time the" music lasts — and possibly for some time after. That 
these movements are essential in the vital phenomena is easily 
verified by studying such cells, e.g., in invertebrata, with the ultra- 
microscope, or even by studying saliva itself. 

§ 220. Additional remarks on Rhythm. 

Let a and c represent the heart-sounds, and b, d the pauses. The ratio b jd is 
remarkably constant, whatever the number of beats per minute. Exercise, excite- 
ment, fever, etc., increase the rate, yet do not alter this ratio. 

The normal rhythm is ab\c\d ; that is, " triple time." 

Double-time is ab fed ; where the sound is " tick-tack," 5 is the same length 
as d (for instance, owing to shortening of d). Such is what occurs in palpitation or 
tachycardia. 

If, however, b becomes long, it shows that the peripheral resistance is greater. 
If a is stronger, b is longer. If the time is still triple, it necessarily implies that the 
pulse-rate is slower. But if this rhythm now becomes double-time, it shows that the 
resistance is too great for the heart, and that the heart is dilating or dilated. This 
happens for instance in chronic renal disease, or acute renal dropsy associated 
with myocardial change. 

Four-time. — i. abjcjdjdj. The contraction is quick, the resistance is low. 
This occurs in fever or in excitement. This rhythm tends to return to triple by 
shortening of c to : abejdjdj. The pulse is short. 

Such a pulse may follow on a double-time pulse ; for instance in chronic renal 
disease. The prognosis is then grave. 

A similar effect is produced if the cardiac contraction is not completed either 
because the muscle is too weak or the resistance too high. To find such a pulse 
forewarns the physician of cardiac asthenia forty-eight hours beforehand. 

2. aajbjcjd. This is met with where the systemic and the pulmonary 
pressure are not equal. The former may be too high from renal disease ; the latter 
may be too high from pulmonary or bronchial disease. Where the heart is hyper- 
trophied, such a rhythm denotes failing heart. 

The second " a " is not usually loud, but it may be as loud as the first " a." 
In such a case one could feel both ventricles beating separately over the apical 
region, ab \c jc jd may appear simply by holding the breath. It may also appear in 
mitral stenosis, in bronchitis with emphysema, in pericarditis, in pleural effusion 
and in cases of cerebral tumour. 

Five-time: a jb jc jc \d ; djbjcjcjd; ajbjc x jejd; or ajbjcjc^jd. These are 
all variants of " bruit de galop." The problem to solve in each patient is : which 
is the source of the second c ? Is it the pulmonary valve ? The causes are the same 
as of the preceding. Pulsus bigeminus : db jc l d j jab jed j jab jc 1 d, etc., in the case of 
the heart, but db jed jab jed j jab jed j etc., in the pulse at the same time. This type 
is found in mitral stenosis under treatment. Another form : ab jed j jab jed j jab jed j j 
etc., in the case of the heart and ab jed jd jd j jab jed jd jd j in the case of the pulse. 
This type is found in more advanced cases, and in cases of epileptiform attacks. 
It simulates alternate action by the two ventricles. Pulsus trigeminus ; 
ab jed j job jee jd j jab jd jd j j 

* Bearing on this is a recent paper by Swale Vincent and J. H. Thompson : 
" the effects of music upon the human blood pressure." (Lancet, March 9, 1929, 534.) 



296 THE CANON OF MEDICINE 

Some heart-beats are too weak to reach the wrist ; or, in some cases too little 
blood enters the heart. The pulse may therefore be irregular though the heart is 
regular ; or the pulse may be moire irregular than the heart. 

2. The Regular and the Irregular Pulse 

535. Some say that irregularity (dissimilarity) of the pulse 
applies- to a succession of beats or to any individual beat. But 
when the irregularity is in the individual beat the various com- 
ponents are diverse, — whether in the various places where one 
applies one's fingers, or only at one particular point of appli- 
cation. 

536. When the irregularity is in regard to several pulsa- 
tions there may be a regular succession of events. This begins 
with one pulsation and there is a change to a greater or lesser, 
following on regularly step by step until a maximum or minimum 
is reached, after which there is a break, and the original cycle is 
resumed. Or, the beats continue at the same level for a time, 
and there is then an intermission and the original cycle is 
resumed. 

The whole cycle may show only one irregularity or it may 
show two or more. In this case, it is as if there were two cycles, 
distinct from one another, and yet keeping to one order, so that 
the whole seems to be just one single cycle. 

The irregularity may consist in the occurrence of a pause 
when one expects a beat, or in the occurrence of a beat in the 
middle of a pause. 

537. When the irregularity refers to several components 
of one single pulsation, this may be in regard to relative position 
or to movement. And as there are six components there will be 
corresponding irregularities : (a) expansion swift or sluggish ; 
(b) premature or delayed expansion ; (c) strength or weakness ; 
(d) largeness or smallness. All of this may be orderly and regular 
or may vary by exaggeration or by deficiency — in two components 
or in three or in four. 

This may all be worked out for oneself. 

538. Irregularity of the pulse in one section* is shown as 
an intermitting or as a recurrent or as a continuous pulse. 

The intermitting pulsef : one component is separated from 
the next only by a short interval and a pause is interposed 
in another, so that the two extremes of the pulsation vary in swift- 
ness, sluggishness, and the like. 

* Juz' : a section of the Quran. . 

t Intermitting pulse : a smaller beat occurs after one or more great pulsations : 
sometimes even the smaller beat is wanting. Intercurrent pulse: this is the 



THE CANON OF MEDICINE 297 

The recurrent pulsef : here a large pulse becomes small in 
one component and then becomes slowly large again. In this 
case there may be two kinds of pulse passing into one another, 
so that, for instance, one pulse, by its irregularity, comes to appear 
like two, or two pulses come to appear like one. Opinions 
about this differ. 

" When the radial artery is completely closed by one or more fingers till the 
direct pulse is arrested, a feeble and retarded beat can be felt in the distal part of 
the vessel. This is because the blood-pressure is low, and the arteries are relaxed, 
and the force of the heart strong." 116 ((p. 52.) 

The continuous pulse is one in which the expansion is con- 
tinual and unbroken. There is a steady increase from slowness 
to swiftness, and from swiftness to slowness ; from equality 
to inequality ; from largeness to smaller, and so on. There is 
no break in the change, for it is continuing the whole time. 
Sometimes there is more irregularity in regard to some of the 
components and sometimes there is less. 

§ 221. Brief summary : — 

Variations in rate of expansion : Sudden ; deliberate ; second expansion quick ; ■ 
or slow ; first sudden and then tardy, or' vice versa. 

Rate of fall or contraction of the vessel : abrupt, or gradual and gentle. 

Variations of degree of expansion : large, small, moderate ; forceful or feeble ; 
alike in every beat or unlike. 

Variations of duration of expansion : first short, then long, or vice versa ; 
momentary ; persisting ; or mean. 

Variations of duration of pause : first short, then long, or vice versa. Pause 
'when there should be a beat ; beat when there should be a pause. 

Variations of size of successive beats or between the beats : first diminished and 
then increased ; first increased, then diminished. The size of the artery between 
the beats informs of the constant pressure in the artery. To ascertain it, rolfthe artery 
transversely between the beats ; it should not be palpable between the beats unless 
the skin is soft and flexible and thin. Inability to feel the pulse between the beats 
means low tension ; if easy to feel, the tension is high. 

Variations in successive beats : the fourth beat may be irregular in one or other 
respect, or the fifth or the sixth or the seventh. Every beat may be different 
(irregular disorderliness). 

3. The Varieties of Irregular Pulse which have received 

Distinctive Names 

539. Gazelle Pulse : [Syn. : goatleap pulse ; modern 
"'jerking" ; "pulsus bisferiens "]. The expansion is inter- 
rupted and occupies a longer time than usual and remains at a 
•certain height and is succeeded by a swift increase to the full 
height. 



t> j 



Just before the wave begins to subside a second heat is felt (Broadbent) — " a 
•swifter spring than before" (Aegenita) — The two phases of the one beat are unequal. 

opposite. When we are expecting an interval of rest, a supernumerary pulsation 
•occurs. (Aeg.) 

These two pulses denote impairment of the cardiac power, the degree being 
greater in the intermittent than in the recurrent. 



2 9 8 THE CANON OF MEDICINE 

Cause : febrile heat. If the commencement of the diastole is feeble, and there 
is increase in velocity towards the end and beginning of the systole, this shows that 
putrefaction is prevailing, nature , hastening on the discharge of the fuliginous 
superfluities But if, on the other hand, the commencement of the systole is feeble, 
and the speed is towards the diastole, this means that heat is prevailing. _ 

In fever cases, such a pulse is accompanied by density, and sometimes by 
largeness, if the artery is not too rigid. (Aeg.) 

(This pulse is characteristic of pericarditis.) 

540. Undulatory [" bounding " (modern) ; " like rolling 
waves "]. The irregularity is in respect of largeness and small- 
ness of artery, of degree of rise, and of breadth, and in the position 
of the beginning of the beat (whether too soon or too late), and 
also in softness. It is not very small ; it has a certain breadth, 
recalling the movement of waves, which follow upon one another 
in orderly fashion and yet vary in the extent of upward rise and 
downward fall, and in swiftness and slowness. 

Aegineta says : " The whole artery is not expanded at once, but first under the 
first finger then under the second and so on ; like a series of waves. The wave may 
be carried on straight or obliquely ; it may be high but short, low but long, broad or 
narrow, unequal in speed and force." _ 

Rhazes says : " It is one which in breadth takes up much space of the finger , 
with this it is soft and full, but there is not much rise or fall ^one rise seems to join 
to another until it resembles waves, one following the other. 

541. Vermicular [modern " creeping "]. This resembles 
the preceding, but is small, soft, feeble, and very hurried. 
The closeness of the beats causes it to be mistaken for a swift 
or rapid pulse. 

The feel is that of a worm wriggling. It is a weak form of the undulatory 
nulse The size of the artery is not of the same inequality at all times. I here 
are waves of pulsation, the whole artery not being distended at the same time 
(Broadbent). See 572. 

542. Formicant Pulse. This is the smallest, most feeble 
and hurried of all the pulses. [It is not a quick pulse, 
though apparently swift. (Aeg.)] It differs from the vermicular 
pulse in the great ease with which upward rise, anteposition of 
beat or postposition is perceived. Irregularity of breadth is not 
discernible. [It is a weak form of vermicular pulse ; and allied 
in character to the " hectic " pulse.] 

543. Serrate Pulse. This [modern " harsh "] pulse resem- 
bles the undulatory in the inequality of the various components 
of the beat — upward rise, breadth, anteposition and postposition. 
It differs, however, in appearing harder, and in its components 
being of unequal hardness. This pulse is quick, hurried, hard. 
The irregularity is in respect of size of expansion, of hardness 
and of softness (see 565). 

544. Mousetail. There is progressive inequality of the 
components — from decrease to increase, from increase to de- 



THE CANON OF MEDICINE 299 

crease. This may apply to several beats or only to one beat or 
only to a part of a beat. The inequality is in respect of volume, 
or of slowness (changing to swiftness), or of weakness (changing 
to strength). 

The artery, says Aegineta, feels swollen to the index finger, and very slender to 
the last finger. _ He speaks of a •" failing or swooning myurus, where the smallness 
ol the last beat is maintained ; and of a recurrent myurus, where the pulse resumes 
its original amplitude." 

545, Recurrent [modern " flickering " pulse]. This passes 
from minuteness to a certain volume, and then fails progressively 
until it reaches its former minuteness. It is like two myuri 
placed together end to end. 

" Your first finger feels it small, your middle finger feels it large and swelled 
and your little finger feels it small ; the expansion is only slight."— (Aegineta ) ' 

Cause : weakness of arterial wall, and wasting of the tissues round the artery 
bigmficance : extreme debility ; wasting from unresolved inflammation or any other 



cause. 



546. Dicrotic. Doctors are divided in opinion about this 
pulse. Some regard it as a single beat in which antecession and 
post-position are unequal ; others regard it as a double pulse, 
one beat following the next too quickly to give time for the second 
to produce full expansion. However, the presence of two beats 
does not make two distinct pulses. A pulse which makes a partial 
expansion and then resumes it, would not be dual. It would 
only be dual if the artery were to fill first, and then pause and then 
contract and again refill ; but otherwise it would virtually be a 
jerking pulse. 

§ 222. _ As regards the dicrotic pulse, some have regarded it as a wave reflected 
from the periphery, but it is really the elastic recoil of the aorta that accounts for it 
It is most distinct if the peripheral resistance is low. The semilunar valves form the 
fulcrum of the rebound (Broadbent, p. 26). 

^ • P? firSt ^ Sat of the P ulse is lar S e < the arter y rism g strongly to the finger • 
then it stops and recedes ; the second beat is small. The artery is as if repelled at 
the first beat and then trembles a little, and then quickly resumes its beat but less 
strongly, and at too short an interval. 

547. Fading or falling pulse. Here there is a pause in the 
middle of the pulsation, as there is in the gazelle pulse. But in 
the gazelle pulse the second beat begins before the first is finished; 
in the falling pulse the first beat is completed before the second 
begins. 

548. The spasmodic, thrilling and twisted pulse. The latter 
is compared with a twisted thread ; there is here an irregularity 
between the precession and the later parts of the pulsation, both 
in position and in breadth. 

The spasmodic (or "tense ") pulse suggests that the artery is being stretched 
and dragged and pulled by its extremities like a cord (Aeg). 

t* Th t "l t 1 hrillin g ".(modern term), or tremulous pulse is hard, quick and frequent. 
It suggests the quivering of arrows thrown with great force (Aeg.). 



3 oo THE CANON OF MEDICINE 

549 The chord-like pulse feels like a twisted cord (or sinew), 
and is similar to the thrilling pulse. But in the chord-like pulse 
the expansion is less conspicuous ; the departure from regularity 
of position of rise is less evident ; but tension is evident ; the 
twisting is sometimes only in regard to one portion of the pulsa- 
tion. The two kinds of pulse are really equally common, and 
equally liable to occur in " dry " diseases. 

All the above are simple pulses. 

550 The varieties of compound pulse (that is, where there 
is more than one form of inequality or irregularity at once) are 
almost innumerable. In any case they have received no special 
names. 

Additional Notes 

s ,,, t The pulse is visible under the following circumstances : when 
the radial artery follows an abnormal course, immediately under the skin ; when 
the Sat ent is spare and the skin is thin ; when the tension is very high, and the 
SoodSessels ar P e enlarged and tortuous; and (entirely pathologically) m aortic 
Sgu«rtation^here the artery is empty and collapsed between the beats and the 
Wood rushes in with extreme suddenness and violence, especially if the hand is 
Sed Such Tpulse may be audible as well, and at the same time there is conspicu- 
ous throbbing of P the carotids and temples and facial artery. The tension is here very 
low indeed. ,, -, 

Visibility is not mentioned in the Qanun ; and whether the empty pulse 
vw= o+ cii with the " Corriean" or not, is not clear. It seems hardly 
l^ffi» ^ **£ should^ot have been observed, even though they 
could not know its explanation. 

S-724 2 Hectic pulse. This occurs in marasmus and phthisis, I tie 
components do no? vary greatly. The pulse suggests " being entangled and never 
geS free » becaule thestateof disease is actually diffused throughout the body. 
fh£ pulse therefore agrees with the Chinese type named like a toad embarrassed 
by weeds." This may be simply a form of the thrilling" pulse. 

S225 3 Pulse-rate. (Broadbent, " s , etc.) 

Increased pulse-rate. -^Lowexed resistance quickens the pulse rate. Diurnal 
variatiZ T the Cse-rate is greater in the evening, and slower m the early morning. 
The fact of theater explains the following: morning headache; tendency to 
depression of "spirits ; to awake tired; the tendency to asthmatic attacks and 
epfleptic fits (tte blood-pressure is now minimal). Posture : the erect posture adds 
e?At beats to the minute. Emotions : the rate is increased by fear (the force is 
fSe) and anger (force violent) ; the explanation is that the tension is increased 
bv the emotion! Exercise : at first the rate is increased as well as the force and 
The pulse becomef" vehement." The explanation is threefold-(«) nervous 
factors (6) musclar action drives more blood to the heart and fills up the right side ; 
the hearths to beat quickly and strongly to get it through ^the dung, ^ accumula- 
tion of blood in the lungs produces breathlessness and panting, hood . tne rate 
S^ncreased after food and the vessels are relaxed. Drugs, etc.: stimulants 
nrrease the rate and cause greater relaxation of the vessels ; alcohol and ether 
belonfto this fate^ry Thef lower the peripheral resistance by acting on the cen- 
^iwuslS^d also stimulate the heart directly; nitrites increase pulse- 
rate and at the same time cause great relaxation of the artery. Pungent essential 
oils and ammonia increase the rate and through the peripheral nerves relax the 
Vessels Belladonna and atropin also increase the rate. External warmth : slight 
increie of rate and slight relaxation of the vessels. Respiratory movements-czuse 
irregularities. 

' s z ,6 Increased pulse-rate in relation to morbid states : — 

These diseases in which the rate is increased, show the same rate, even m 
repose but exertion makes the rate increase inordinately, out of all proportion. 
Emotional disturbance has the same effect. 



THE CANON OF MEDICINE 301 

In pyrexia : the rate rises according to the degree of fever, but chiefly according 
to the effects on the system and according to the patient's reaction to the disease 
The peripheral resistance falls. The force may be increased (sthenic fever : pulse 
frequent, sudden, vehement, large, short, dicrotous) or diminished (pulse weaker 
less sudden, less large, dicrotous). Towards the end of the illness, the weaker the 
patient, the greater the rate ; even a few beats more per minute are serious In 
septic fevers (septicaemia : modern term) a quick rate forewarns of shock, and a 
fatal issue (in puerperal cases). A " racing " pulse is a danger sign. 

Among special fevers : scarlet fever is characterized by a very quick pulse- 
rate (120-200). - ■/ •> u .r 

§ 227. Specially quick pulse-rates. — In young people : overstrain from 
athletics; the "irritable heart" (the blood-pressure is high). In older people- 
sudden single acts of excessive exertion (sudden dilatation of the heart). Special 
cases : paroxysmal tachycardia : due to flatulence, emotions, gout ; gastric trouble 
The pulse is frequent, short, variable in fulness and strength, not vehement, occasion- 
ally irregular. The heart-sounds are confused and short, . and cannot be analysed. 
May arise suddenly from a fright or sudden noise, or violent emotion. 

(In this condition the motion of the blood is not accelerated. It is a vibratory 
alternation of pressure with little onward movement. The left ventricle is not 
dilated._ It may be that the ventricle is not expanding properly. Cf. auricular 
fibrillation ; auricular flutter. This form of pulse must be among those described 
by the Chinese, but certain identity has not been reached). 

The quick pulse of " Graves' disease" might be included here. 
Middle-aged and elderly women : here the occurrence of throbbing aorta may 
be referred to, though it is not a true " quick pulse " ; it arises from lack of tone in 
the aortic wall. 

§ 228. Decreased pulse-rate. Increased resistance slows down the pulse 
Habitually low pulse-rate (bradycardia) forewarns of the risk of cramp when 
swimming. In this category belong— the slower rate of jaundice ; of fatty degener- 
ation of the heart (not often met with here) ; the special pulses : pulsus bigeminus 
and pulsus trigeminus : heart-block. 

§ 229. 4. Intermissions. Irregularity. 

On the one hand there is a variation of force between successive beats ; on 
the other hand there is a drop of a beat, or an interposition of a beat. 

Intermissions may be habitual or constant, the person being unconscious of 
it except during exercise or excitement. It is accentuated when the body is fatigued 
or the disposition is nervous. The patient is conscious of it during pyrexia. 

Occasional intermissions are produced in shock ; in hypochondriasis after the 
use of tobacco ; in fatty degeneration of the heart. In these cases the heart itself 
is beating, though hurriedly and imperfectly. 

Irregularity is habitual in mitral regurgitation, where it is produced by the 
variations of pressure dependent on breathing. Inspiration forces blood into the 
left ventricle, expiration sucks it out of the left auricle. A similar occurrence 
is found when _ the heart is dilated, and under nervous conditions. 

Irregularity is occasional as a result of flatulence of the colon, or stomach 
which disturbs the action of the diaphragm ; as a result of tobacco. 
Irregularity is usually more serious than intermission. 

Rules in regard to intermission found in Chinese textbooks : — Omission of 
one beat after forty shows a lack in one of the five " noble " organs : " death will 
follow m four years, in spring." If there are no intermissions within fifty beats, the 
health is perfect. But if there is an intermission then, it has a similar significance 
to the preceding and shows " death will follow five years later." (See § 218.) 

Other rules cannot be presented without also discussing the theory of the 
relation between pulse-type and physiological value of the several organs Thus 
an intermission of one in 12, or 19, or 26 (and so on), beats differs in significance 
according as the pulse-type is' " heart," " lung," " liver," " kidney," and so on.— 
After all, such a classification is justified, and it should be easily understood that 
intermissions under such circumstances might have distinct significances. 

§ 2 3°- 5- Relation of pulse-rate to respiration-rate. In the Chinese works 
this form of observation replaces our own habit of estimating the number of beats 
per minute, and also the number of respirations per minute. In health there should 
be four beats to one respiration ; five beats in the same period is allowable as consis- 
tent with health. But over five is pathological, and eight beats is a bad prognostic 
™f?' reductl0n to three or two is pathological and a reduction to two is a bad sign 
When death is imminent there may be only one beat to two respirations. Full 
details are stated to be given in " the book of eighty-one difficulties " 



3 o2 THE CANON OF MEDICINE 

4. The Pulse designated as " Natural." 

551. Each of the above-named varieties (of pulse) neces- 
sitates a distinction into " increased " and " diminished." And 
that which is " natural " among them is the " equable " pulse, 
except in the case of the strong sort. For (here) the " natural " 
pulse is excessive as" to strength. But in other cases, the increase 
is in natural proportion to the increase in force, so that, for ex- 
ample, as it becomes greater, it is " natural " for it also to be 
forcible. 

As for the sorts (of pulse) in which there is no possibility 
of increase and diminution, in such cases the " natural " pulse 
is the one which is even (equable), regular (orderly), and of good 



rhythm (weight).* 



Paraphrase. 

Amongst all the varieties of pulse which have now been des- 
cribed, there are two classes, (i) Those which show degrees of 
qualities : namely, increase above, and diminution below, a " mean." 
(See 521-528). (ii) Those which do not. Thus, a dicrotic 
pulse cannot be more, or less, or intermediately dicrotic ; an ir- 
regular, pulse cannot show a " mean " irregularity. 

The " natural " pulse in the first group is one which shows a 
mean quality in respect of every feature except that of strength (523) 
for the natural pulse is strong (forcible). 

The " natural " pulse in the second group is one which is 
uniform, regular (orderly), and eurhythmic. 

This rendering brings out the real meaning of the word " natural " — tabi'yya. 
It is not synonymous with " normal," but refers strictly to " the nature "-—i.e., 
the state of the vegetative soul, when in health. (< ;j 

In short, a pulse which is " mu'tadil " is not therefore necessarily " normal ; 
still less is it necessarily " natural." 

A pulse may be (a) natural and normal, (6) not natural, yet not abnormal, 
(c) not natural, and also abnormal. 

5. The Factors concerned in the Production of the 

Pulse 
552. The factors concerned in the production of the pulse 
are (i) essential and integral in the constitution of the pulse. 
These are called " contentive " factors ; (ii)_ non-essential : 
comprising two groups, (a) inseparable — that is, if they were 
altered, the type of the pulse would be altered ; {b) separable ; 

* It may be noted that the close resemblance between the Latin version and the 
corresponding passage in Galen makes it seem as if Avicenna had simply introduced 
a translation into Arabic from Galen. But in the Greek the natural pulse is simply 
a mean between extremes, and is so called presumably because usual m health; 
whereas with Avicenna this is not so ; he speaks of a distinct kind of pulse, and is 
truly consistent to his usage of the term " nature "—the outcome of the great 
thesis "the body is a unity "—throughout his physiology, pathology, and 
sphygmology. 



THE CANON OF MEDICINE 303 

that is, a change may be produced in them without- affecting 
the type of the pulse. 

There are three contentive factors : 

1. The (vital) power of the heart, producing the 

expansion. 

2. The elasticity of the artery. 

3. The resistance, or urge. 

The last-named is, in Avicenna, taken to be a question of the degree of innate 
heat, and its relation to heat-loss ; not a question of peripheral resistance as a factor 
m producing blood-pressure. 

The influence of the three factors varies with the non- 
essential factors which may be associated with them at the given 
time. 

553. List of non-essential factors : 

1. Natural (i.e. pertaining to the nature) — Age (manhood, 
youth) ; temperature of air (hot seasons ; hot localities) ; tem- 
perament (hot temperament). 

2. Non-natural : exposure to very hot atmosphere ; use 
of hot baths ; vigorous exercise or gymnastics ; influence of 
food and wine ; influence of calefacient medicines. 

3. Preternatural : emotional states ; secretiveness (hiding 
anger, concealing the fact of having taken a heating medicine 
in spite of the physician's enquiry) ; cunning persons who easily 
conceal matters relative ; habits of the patient ; " hot " in tem- 
peraments ; decompositions occurring in the fluids (in the 
stomach or tissues). 

6. The Effect of the Contentive Factors upon the 

Pulse 

554. Large Pulse. If the arterial wall is at the same time 
yielding, and the vital power is strong, and the resistance 
excessive, the pulse will be large. The resistance is the chief 
factor in the production of a large pulse, for should the power 
fail, the pulse will naturally weaken ; and if the arterial wall 
were also hard, and the resistance lowered, the pulse would be 
even smaller. 

An unyielding artery will also make the pulse small. But 
the difference between a small pulse due to inelastic artery and 
one due to weakness is that in the former the pulse is hard and 
not weak or short or low as in the latter. 

Low resistance also makes a small pulse, but it is not weak. 
Weakness is the chief cause of all three forms of small pulse. 
Granted the power is constant, lack of hardness of the artery 



3 o 4 THE CANON OF MEDICINE 

has more effect than lack of resistance, for there is nothing to 
prevent the artery from expanding. 

The temperament has not much influence unless the resist- 
ance be lowered. 

If the resistance be great and the power strong, and the 
artery inelastic, the pulse becomes swift. The swiftness makes 
up for lack of size of pulse. But if the power be not adequate, 
and the pulse is therefore unable to become large, and therefore 
not swift, it necessarily becomes brisk, and this briskness makes 
up for the lack of volume and swiftness. Several beats of this 
kind would become equivalent to the effect of one adequately 
large beat, or of two swift beats. 

555. It is like a man wishing to carry a very heavy weight ; 
if he is able to do so, he will carry it in one journey, though with 
difficulty ; or he may divide it into two, thus making each 
journey more easily ; or, if he cannot manage even that, he will 
divide the load into many portions, and carry each one as leisurely 
or as quickly as he wishes. He need not rest himself between 
the journeys, though he may choose to linger. But if he were 
very weak, he would stop and rest awhile between the loads, 
and as he becomes tired with the journeys would perform them 
more slowly. 

556. If the vital power be strong, and the artery responsive, 
and the resistance moderate, the effect of the power would be 
to make the pulse more swift and of greater volume. But if the 
resistance were greater, there would be briskness as well as large 
volume and swiftness. 

557. The factors which go to make a large pulse also go 
to make a long pulse, if rise and fall are hindered in any way. 
For instance, a hard artery cannot widen, and tough flesh and 
skin, especially if the tissues be wasted, prevents the artery from 
rising to the finger. 

Variants of Large Pulse, and their causes (Aeg.) :— 

Large and also soft : hot baths. 

Large and also hard : hot intemperament, especially if there is dryness of the 

system. 
Large and mean between hard and soft : massage ; exercise. 
Large and vehement : wine ; anger. 
Large and unequal: concealing anger; deceiving the doctor m regard to 

definite questions, as to possibility of heating factors. 
Large and also a hasty contraction : putrefactive changes in humours. _ 
Large and also quick and dense : increase of heat in the heart from various 

causes. . , . . , 

Large only in appearance : emaciated state of the tissues at the wrist. 

558o The Causes of Pulses bearing Distinctive Names 
Broad Pulse. Emaciation may make a pulse appear broad. 



THE CANON OF MEDICINE 305 

Emptiness of vessel also makes a pulse appear broad, 
because the two walls come into apposition. A very soft artery 
gives the same effect. 

Causes of broad pulse : redundance of humidity from natural causes or from 
external causes, such as a soft artery (Aeg.). 

559. Hurried pulse. The causes of a hurried pulse are : 
weakness ; great resistance ; heat. 

560. Sluggish -pulse. The causes of a sluggish pulse are : 
power relatively greater than resistance ; great coldness due to 
resistance ; great loss of vital power ; approach of death.- 

561. Feeble pulse. The causes of feeble pulse are : loss of 
natural power by lack of food ; emaciation ; excessive discharges; 
insomnia ; too much exercise ; solicitude ; morbid change in 
the humours ; movement of the humours, especially into a very 
sensitive member, or into a member which is in relation with the 
heart; any source of intemperament ; pain (producing syncope) ; 
sadness, grief and other mental states or cares ; any factor 
whereby the vitality is markedly depressed. (Note also : age, 
season, locality ; temperament.) 

Cause of change from feeble pulse to strong pulse : la) when the vitality 
becomes strong again, after being enfeebled from lack of food, wakefulness im- 
m ? ^ ® vacuatl0ns « g rief > cares, syncope, or any cause of intemperament. 
(d) When humours are matured ; when noxious substances are excreted when there 
is passion, when an intemperament is rectified ; also after use of certain foods 
of wines ; after exercise. (Aeg.) ' 

562. Hard pulse. The causes of hard (" tense ") pulse 
are : dryness of the arteries and great stretching of the arteries ; 
intense cold.^ The pulse may become very hard at the crisis of 
an illness owing to the intensity of the conflict between the person 
and his disease, for all the members are implicated. (This pulse 
is usually also small, quick, and sometimes frequent.) 

Hard pulse must be distinguished from a strong pulse. The latter is usually 
also large, swells up and strikes the finger forcibly. A hard pulse cannot be large 
for the artery is unyielding ; a hard pulse is also small, quick, and sometimes dense' 
(Aeg.) 

Causes of hard pulse : hardness of artery; this is due to immoderate cold 
dryness, or tension of inflammation, or spasm. (Aeg.) 

Cause of strong pulse : the force of natural vitality, associated with hardness 
of the artery (Aeg.). 

563. Soft pulse. The causes of soft pulse are : "natural" 
agents with an emollient action, such as aliments (more abundant 
diet ; liquid food). Morbid states which tend to emollient 
effect : e.g. dropsy, sleepy-sickness, coma, disorders arising from 
or m a serous humour. Mental states, such as hilarity. Agents 
which are neither " natural " nor morbid : e.g. bathing (to- 
excess). 



3 o6 THE CANON OF MEDICINE 

Other causes (Aeg.). : humid state of artery due to (a) preternatural causes : 
coma, lethargy, dropsy, affections related to the serous humour. (6) Non-preter- 
natural causes : more liquid food, much sleep, a more abundant diet, immoderate 
baths ; hilarity. 

564. Irregular pulse. If the vital power be maintained, the 
cause will be heaviness [in substance] of the food, or of some 
humour.- If the vital power be weak, it shows a contest between 
causative agent [of "the illness] and the tissues. Other causes : 
(a) overfullness of the vessels. This would be remedied by 
venesection. ( b) Viscidity of the blood. In this case the breath 
becomes choked in the vessels. This form of pulse is especially 
liable to occur when the breath is also imprisoned in the cardiac 
region — e t g, by an over-full stomach, which produces this effect 
very rapidly ; or by anxiety ; or by pain. 

If the stomach contain depraved humour, the irregularity 
increases until cardiac tremor comes on, and a thrilling pulse 
(tachycardia !) results. 

If the irregularity is orderly, it betokens lesser constitu- 
tional injuries ; if disorderly, it shows that there are more 
serious constitutional defects to deal with. 

565. Harsh -pulse. This pulse shows a varying consistence 
of the artery which is produced by changes in the composition 
of the (circulating) humours, whereby decomposition products, 
" crudities," or products of maturation diffuse through the vessel 
wall and affect its mode of expansion. Inflammatory deposits in 
fibro-muscular organs (e.g. diaphragm, pleura : "Rhazes) also 
render the pulse harsh. 

If the harshness be slight, it shows that the inflammation is mild ; if more 
marked, it means that the case is severe and dangerous, with a danger of empyema 
or tuberculous change (Aeg.). See 543. 

566. Dicrotic pulse. Vital power is strong ; the artery is 
hard ; the resistance is considerable. The artery does not at 
once yield to the force. It suggests a person wishing to sever 
something at one blow, but failing to do so until helped out, for 
instance by a sudden dire need to achieve it. (Significance : 
approaching crisis). 

567. Mousetail. Such a pulse is produced when the^ vital 
power is weak, as a person who ceases manual labour, or is re- 
suming it after a rest. If it is constant, it shows that the loss of 
power is greater. However, as long as the pulsation is mousetail 
in type (and the similar forms) it shows that there is some vitality 
left. But it is apt to pass on to the terminal mousetail, then to 
continuous mousetail, and finally end in the grave " recurrent 
mousetail " (" swooning " pulse). 



THE CANON OF MEDICINE .307 

Recurrent mousetail means : (a) failing vital powers, with a greater or less 
■degree of prostration ; (6) weak power, which is still struggling on in face of the 
•odds (Aeg.). 

568. Fading or falling pulse. The vital power is enfeebled 
or waning, and inadequate. It is also produced by a sudden 
change in the " nature " and in the mind. 

569. ■ • The spasmodic or tense pulse. This is produced when 
there are non-natural movements in the vital power or when the 
artery is itself unhealthy. 

Significance : inflammatory changes at the nerve-origins (meningitis, acute 
epilepsy). It can be felt after death has taken place, while the body is still warm 
{Aeg.). 

570. Thrilling pulse. Here the vital power is strong ; the 
artery is hard ; the resistance is great. Without these conditions 
it cannot arise. 

It denotes inflammation in fibro-muscular tissues which are well supplied 
with nerves. A strong expansion is required, with adequate vital power. The 
hardness of the artery prevents adequate expansion. 

^571, Undulatory pulse. This usually means chiefly a lack 
of vital power, expansion being hardly achieved, if at all, and 
then only little by little. If the artery is soft, this would itself 
suffice to produce the effect of waves, even though the power 
were not much reduced. A soft and moist artery does not respond 
to an impact, and does not allow every part to be expanded ; 
whereas a dry and hard artery does — dryness being responsive 
to impact and tremor. An artery which is both hard and dry 
will transmit expansion at once ; the soft and moist artery will 
only do so at the beginning of the pulsation, expansion and alter- 
ation of form of the vessel subsiding suddenly so that the other 
fingers do not perceive any movement. 

The beats are indistinct ; the dicrotic waves blend. At the same time the first 
cardiac sound disappears. 

Significance : crisis approaching by sweat (Rhazes, Halv Abbas), or by 
bowels ; humid affections like sudden dropsy, lethargy, peripneumonia' (Aeg ) • 
typhoid fever ; and malaria ; extreme cardiac asthenia (Broadbent). 

572. Vermicular and formicant pulse are produced by great 
weakness, and so the pulse is sluggish, the intervals between 
the beats are short, and the components are unequal. This is 
because the artery is unable to expand at once, but onlv little 
by little. (See 541.) 

Significance : sudden loss of vital power due to excessive haemorrhage diar- 
rhoea, cholera, etc. Failing life (Galen). 

In the formicant pulse the powers of life are at a still lower ebb than in the case 
of the vermicular pulse (Aeg.). 

Chinese simile: to a silk thread (§214). 



3 o8 THE CANON OF MEDICINE 

573. Pulse of faulty rhythm. If this occurs during a time of 
repose, it is due to an increased resistance. If it occurs during 
exercise, there is an increased -weakness (of vital power) or de- 
ficient degree of resistance. The pulse of exercise produced by 
swiftness of expansion is something different to this. 

The' duration of the pause is lessened in old age. Equality between expansion 
and pause denotes a normal temperament of the body. It occurs m early life 
If the pause is greater in duration than the expansion, the temperament is hot 
(e.g., adult) . If the pause is less than the expansion, it shows that the temperament 

iS COl Change t of rhythm changes the rate and frequency of the pulse. (Aegineta.) 

The causes of full, empty, hot and cold, deep (high) and 
low pulses are evident. 

Full Pulse is produced by plethora from food or wine ; or any mere abundance 
of fluid-intake ; empty pulse is produced by lack of nourishment, or undue dis- 
charges The pulse Jells warm (af if there is great heat in the heart-the rest of the 
bodv being cold ; (b) if the artery is in a sort of spasmodic state ; (c) m catalepsy, 
and in persons who are becoming comatose. (Aegineta, quoting Archigenes.) 

§ 2 ,j The influence of low resistance upon the pulse. Ihere is a sudden 
impact ; the acme is brief ; the subsidence rapid and the dicrotic wave « present 
As it subsides quickly under the fingers it is called hurried If at the same time the 
heart beat is forcible, the pulse is '< full and bounding '-large sudden impact 
vehement ; artery easily flattened. If the heart is beating feebly, the artery is 
narrow ; the pulse is small, easily compressed ; the impact is not sharp and there- 
• fore the fingers must be applied very lightly in order to be able to feel the pulse. 
An extreme degree of this kind of pulse constitutes the running pulse, bphyg- 
mographic variants are : hyperdicrotic, and " anacrotic (which is a form ol 

' ' &7\ yell© ) 

Clinical causes of low resistance : (a) congenital, (b) transient : after a hot 
bath in fatigue, in exhaustion ; after a meal, especially a hot meal ; lack of nitro- 
genous aliments ; alcohol, (c) Emotional : anxiety, depression (d) Morbid states : 
obesity fever; flatulence; constipation; sleeplessness; headache; nervous, 
conditions ; chlorosis ; fatty degeneration of heart. . 

Other facts— A low resistance occurring in a person with a high tension is- 
a bad sign ; a person suffering from habitual constipation, and having a low blood- 
pressure? should not be given purgation, much less mercurial purgation. 

8 2^2 The influence of high resistance (high tension) on the pulse. This 
depends on the force of the heart. The pulse is full between the beats ; the artery 
feels like a tendon or the vas deferens ; or is even visible under the skin lhe 
arterv is large or small. It may be thrown into a curve ; there may be nodosities- 
along the artery. The wave is gradual ; lasts too long ; subsides too slowly ; seems- 
weak but is more plain when one presses harder. There is no dicrotism. 

A variant called " virtual tension," is where the artery is large and full be- 
tween the beats ; moderate pressure does not make the pulse seem stronger ; it is. 
compressible • the impact is sudden, the acme is short, and the subsidence is sudden. 
Such a pulse shows that the heart is unable to cope with the resistance. 

Clinical causes : excitement ; exertion ; external cold (which drives the blood 
from the surface) ; migraine; early meningitis ; early acute nephritis (the water 
cannot get out through the kidney) ; plethora ; presence of certain waste products, 
in the blood which cause the small vessels to contract. 

§233. Types of pulse and various conditions (modern). 
Sleeplessness.— Two types of pulse, (a) Impact gradual ; acme long ; may sub- 
side suddenly ; artery large or small ; full between beats, and usually not easily 
compressible. It may be weak and yielding. The condition m this respect depends. 
on the state of the heart. (6) Impact sudden ; acme short ; artery full between 
the beats • low tension. A sleepless person with such a pulse will be able to sleep 
readily in the daytime ; he may be able to sleep sitting up though unable to do so. 
lying down. The pulse is unstable. 



THE CANON OF MEDICINE 309 

Emotional excitement.— -Impact strong ; rate increased. 
Fevers : — 

Catarrhal. The pulse varies according to the degree of obstruction to the 
pulmonary circulation (bronchitis, e.g.). 

Pneumonia. Pulse frequent, large, vehement, dicrotic, not short, not com- 
pressible. The pulse can be felt with the third finger after pressing hard with the 
index finger, because the pulsation goes round the radial arch. When the lungs 
become engorged more and more, the artery is small, the beat is weak, but the heart 
itself is very, forcible, working hard to get the blood round the lungs Violent 
heart action and weak pulse 4 (Venesection indicated !) 

Diphtheria. At first the pulse is weak and small especially if the heart is 
affected. The heart rhythm is abjcjdjd or ab jc jd jd jd Id. 

Erysipelas. Large, soft, very dicrotic ; tends to become undulating. 

Septicaemia. Artery small ; pulse rate 140-200 ; beat sharp ; compressible ■ 
tick-tack "heart. The pulse varies much in different cases. 

Pyaemia. Pulse frequent, and sharp, apart from the degree of pyrexia The 
pulse is that of shock. 

Acute rheumatism. The character of the pulse varies with the degree of in- 
flammation in the joints, etc. 

Inflammation of serous membranes. First, small, long, frequent, hard, full 
between beats ; not easily compressible. Later — shock : very small, weak 'com- 
pressible ; " wiry " or *' thready " pulse due to the filling up of the abdominal vessels. 
These characters are more noticeable with peritonitis than -with pleurisy. 

Cerebral conditions : — 

Tumour. Rate slow ; artery full between beats. Later on the impact is 
very weak, and the acme short ; the artery small ; the artery empty between beats 
{denoting feeble heart and relaxed arteries). 

Coma. The pulse varies with the state of the heart. 

Convulsions. Impact strong ; rate increased ; tension lowered ; the blood- 
pressure is sometimes increased, sometimes low. 

Epilepsy. Low tension is a bad sign ; if a high pressure is present and con- 
tinues, the case is tractable. The tension is always high in senile cases. 

Meningitis. Early cases show the " hesitating " pulse ; the force is not 
■quite constant ; the time is not quite regular. The impact is deliberate, the acme 
long ; the artery is contracted. The rate is slow. Later on, the rate becomes 
■quick; there is no tension (owing to compression of the brain). 

7. The Effect of Age and Sex on the Pulse 

574. Male Sex. The pulse is larger and much stronger, 
because the vital power and the resistance are both marked. The 
pulse is slower and more sluggish than in women because the 
degree of resistance is so great. 

If the vital power is maintained, and the pulse is brisk, it 
must needs be swift. Swiftness comes before briskness. Hence 
the pulse of males is slow, and is necessarily also sluggish. 

575. Late childhood (7-14). The pulse is softer because the 
temperament is moist at this period. It is weaker and more brisk 
because the innate heat is abundant. The vital power is not great, 
for growth has not yet become complete. Considering the small 
size of the body at this age, the pulse is large. This is because 
the artery is very soft and the resistance strong, and the vital 
power is not small — considering the small bulk of the body (at 
this age). Compared with the pulse of adult life the pulse at 
this age is not large but quick and more brisk (due to the resist- 
ance). This is because at this period of life there is a greater 



3 io THE CANON OF MEDICINE 

aggregation of •" fumosities,"* consequent on eating so 
often and so liberally — -wherefore more frequent evacuation 
becomes called for and " ventilation " of the innate heat is 
desirable. 

576. Early adult life (2 1-35). The pulse is large, not very 
swift—indeed inclined to be slower and less brisk ; the 
tendency is to become sluggish. At the beginning of this 
period of life the volume of the pulse is greater ; and at the 
middle of the period it is stronger. The innate heat, as we have 
stated, is about the same in adolescents and in young adults ;. 
there is therefore about the same resistance in each. The vital 
power is greater at this period, and the greater volume of pulse 
therefore "compensates for the lack of swiftness^ and frequency. 
Vital power is the main reason for the pulse being large at this 
time of life. The resistance is next in importance, and the state 
of the arterial wall is the contributory factor. 

577. Elderly persons. The pulse is here smaller because 
of the weakness of the vital power ; the swiftness is lessened 
both because of this and because of the lessened resistance. Such 
a pulse is therefore more sluggish. 

578. Old age. In advanced years of life, the pulse becomes 
small, sluggish, slow. If it be also soft this is because of extra- 
neous, and not natural, humours. 

§ 234. From the Chinese. — In the male sex, the pulse at W should be more 
brisk than at C ; in the female sex it should be more brisk at C than at W. From 
deviations of normal character of the pulse in women one may become aware of 
menstrual errors ; of the presence or not of pregnancy, and the size of the pregnancy. 
The C pulse is noted for these purposes, and the right arm is used. — The exact 
details required for diagnosis require the application of the special nomenclature 
of pulses which is richer in variety and subtlety than that of the list of § 213. 

A °e Bloom of life : pulse firm and full ; persons of nurture may show a 
slow thini even soft, pulse, uniform at C, W, and G ; if not uniform, such a pulse 
is a sign of shortness of life. 

Old age : the pulse is slow and weak. Some old men have the pulse of long 
life "—strong, firm, fairly swift, not skipping. (The presence of a skipping or 
hesitating character would show that the strength of the person is outward, and 
that life would not reach an extreme length.) 

8. The Pulse in the Various Temperaments 

579. Hot temperament. The resistance is great. If the 
vital power and artery correspond, the pulse will be large. But 
if one of them do not correspond, the pulse will vary in the manner 
already described. 

If the heat is not due to an intemperament, but is natural, 
the vital power will be very strong, and the heat increases. But 
one must not suppose that the increase of innate heat, to however 

* Dukhani ; lit. smoke or mist. 



THE CANON OF MEDICINE 311 

great an extent, will lessen the vital power. For, on the contrary, 
the power of the breath becomes greater, and the mental qualities 
show more boldness. 

If the heat arises from intemperament, the greater the 
degree of heat, the greater the weakening of vital power. 

Cold temperament. The pulse is reduced in breadth, and so 
becomes small, slow and infrequent (sluggish). If the arteryis soft, 
the pulse increases in width, and also becomes slow and infre- 
quent. But if the artery be hard, the breadth will lessen. The 
weakness produced by a cold intemperament is greater than that 
produced by a hot intemperament because the heat of the latter, 
for^ instance, is then more correspondent (i.e. in slowness or 
activity) than is the innate heat. 

Moist temperament. The pulse is here soft and wide. 

Dry temperament. The pulse becomes hard and wiry. 
If the vital power be strong and the resistance great, the pulse 
will become dicrotic, or spasmodic, or thrilling. 

These remarks will suffice in regard to the relation between 
the several temperaments and the simple types of pulse. The 
effect on composite pulses can be worked out from the principles 
already explained. 

580. It may happen that a person may have a dual tem- 
perament, one side being cold and the other hot. The pulse will 
then be different on the two sides, according to the heat and cold 
respectively. In the one case it will be like the pulse in hot 
temperament ; in the other like that in cold temperament. 
From this we learn that the expansion and contraction of the 
pulse is not merely an effect of the ebb and flow of cardiac action, 
but there is also an expansion and contraction of the arterial 
wall itself. 

9. The Effect of the Seasons on the Pulse 

581. Spring. The pulse is equable in all respects except 
in strength, which is above the mean. 

Summer. The pulse is quick and brisk, because of the re- 
sistance. It is small and weak because the vital power is dispersed 
by the dispersal of the breath (which in its turn is due to domin- 
ance of undue external atmospheric heat). 

Winter. The pulse is more sluggish, slow, weak, and 
therefore small. This is because the vital power is lessened. 
In some people the heat is retained interiorly and aggregated 
together, thus making the vital power stronger. This is espec- 
ially so if the temperament is hot, for then the external cold is 



3 i2 THE CANON OF MEDICINE 

overruled and prevented from passing inwardly, as would other- 
wise occur. 1-1 

Autumn. The pulse is unequal and tends to a certain weak- 
ness. ~The inequality is due to the frequent changes of tem- 
perament which occur during this season owing to the fluctu- 
ations of temperature. The temperament is now hot, now cold 
accordingly. The weakness is due to two causes : (a) a contrary 
temperament always renders the injurious effect of a nocument 
greater than a similar but equable temperament would, even 
though that be a morbid one ; (b) autumn is a season antagonistic 
to life because at this period the innate heat is lessened and dry- 
ness dominates. 

At periods between the seasons, the pulse corresponds to 

the adjoining season. 

The pulse at each season also has its own appropriate 

rhythm. 

§ 235. The following details from the Chinese work are tabulated for con- 
venient survey : — 



Month and Season. 



Dominant 

element 

(Chinese name) 



First 


Spring 


Second 


Spring 


Third 


Fifth 


Fourth 


Summer 


Fifth 


Summer 


Sixth 


Fifth 


Seventh 


Autumn 


Eighth 


Autumn 


Ninth 


Fifth 


Tenth 


Winter 


Eleventh 


Winter 


Twelfth 


Fifth 



mu 

mu 

t'u 

huo 

huo 

t'u 

chin 

chin 

t'u 

shiu 

shiu 

t'u 



Type of Pulse. 



Tremulous : long. 

Moderately slow : strong : hard. 
Superficial : strong : " scattered. 

Mod.' slow : strong : hard. 
Superficial ; short ; brisk. 

Mod. 'slow: strong: hard. 
Deep : soft : slippery. 

Mod. slow : strong : hard. 



If the pulse proper to one season is met with during a different season this 
is usually to be regarded as morbid, and may betoken a long or a short or a fatal 
illness according to the particular inversion. The autumn type m spring ; the 
winter type in summer ; the summer type in autumn, are grave signs 

It is to be noted that the third, sixth, ninth, and twelfth months form a fifth 
season, and are not counted under the corresponding season. These months there- 
fore correspond to those named in Avicenna periods between the seasons The 
pulse changes are definitely specified in the above table, though only spoken of 
generally in the Canon. 

10. The Effects of Locality on the Pulse 

582. Some regions are temperate and vernal ; some are 

hot and aestival ; some are cold and winterly ; some are dry 

and autumnal. The character of the pulse will follow the 

statements made in regard to seasonal influences upon the pulse. 



THE CANON OF MEDICINE 3I3 

ii. The' Effects of Food and Drink 
583. Aliments (lit. substances entering the body from with- 
out) alter the condition of the pulse according to their quality 
and quantity, (a) By quality, one refers to the calefacient or 
mirigidant nature of the substance in question, which has a 
corresponding effect upon the pulse, (b) As regards quantity— 
if the amount of aliment is moderate, the pulse shows an increase 
of volume, swiftness and frequency, owing to the increase of 
vital power and innate heat resulting ; this change in the pulse 
lasts a considerable time. 

If the amount be unduly great, the pulse will become 
irregular and disorderly, because the burden of the food overrules 
the vital power ; any overloading renders the pulse irregular. 
Archigenes thought that the swiftness of the pulse exceeded 
the frequency, as long as the excess of food existed. When the 
excess came to be less, the pulse would show an orderlv irregu- 
larity. J 6 

If the amount be unduly small, the pulse becomes irregular 
both in volume and swiftness. In this case the duration of the 
change would be short because so small an amount of food 
would be rapidly digested. 

If the vital power is weakened, whether the amount of food 
taken be small or large, the pulse corresponds in smallness and 
slowness until the digestion of the meal is completed. 

If the natural (vegetative, digestive, maturative) faculty be 
strong, the pulse will be equable. 

584. Effect of wine on the pulse. Wine has a notable effect 
on the pulse, in that if taken plentifully, being attenuated in 
nature, it gives rise to an irregular pulse,' but not to so great an 
extent as other similarly nutrient aliments. This is because its 
substance is too rare, attenuated, and light. Being in actuality 
cold, wine,- like other cold things, lessens the pulse-rate and 
makes it slow and infrequent in proportion to the rapidity with 
which it enters the body. Once it has become warmed bv the 
body the initial effect passes off. 

The heating effect of zvine. The heating effect which wine 
produces is not very different from that of the innate heat, for 
wine is rapidly distributed through the body, especially if taken 
warm, and _ it undergoes rapid dissipation or resolution. If 
taken cold, it exerts an injurious effect on the pulse of a kind not 
shared by other cold articles of food, for the latter become warm 
only gradually and do not reach the blood as quickly as does 



3 i 4 THE CANON OF MEDICINE 

wine, and they are therefore warm when they do so. But 
wine is absorbed so quickly that it has to be warmed by the 
blood itself, and this constitutes a noxa for such persons as are 
sensitive to cold. This injurious effect is not as great in degree 
if the wine is taken warm, because the natural faculty then 
counteracts it by breaking it up, distributing it through the body 
and finally dispersing it. 

The cooling ejject of wine. Wine has a cooling effect when 
it causes the natural power to fail, so that the pulse loses its 
strength before the wine has become broken up, distributed and 

dispersed. . . 

Such is the manner in which the use of wine in quantity 

produces a heating or a cooling effect. _ 

585. When we study the question of how the use of wine 
can make the pulse strong, other factors must be considered. 
Its own intrinsic character invigorates healthy persons ; it 
enhances the vital power by securing a rapid accession to the 
" substance " of the breath. 

Although the heating and cooling effects above explained 
are injurious to most persons, there are some whose temperament 
is suited bv it. Cold things, for instance, are tonic for persons of 
hot intemperament. For, as Galen truly said, the juice of pome- 
granate is strengthening for persons of hot intemperament ; 
honey-wine is tonic for those of cold temperament. _ 

Wine may therefore be considered to be hot in nature, in 
that it is tonic for persons of hot temperament ; cold in nature 
in that it is tonic for those of cold temperament. Still, this 
question is aside from our purpose. We are concerned with the 
fact that is speedily accedes to the breath, as an intrinsic property ; 
and that from that point of view it is always invigorating. 

The pulse becomes stronger if either the invigorating effect 
is exerted or the warming effect. It becomes weaker if neither 
occurs. By warming the body the resistance [i.e. the blood- 
pressure] is increased ; by cooling the body the resistance is 
diminished. But the usual action is that the pulse becomes 
stronger. Moreover, resistance [blood-pressure] is never in- 
creased without rendering the pulse more swift. 

588, Water. Water has a similar invigorating effect to 
wine, because it is the means by which the aliment is enabled 
to permeate all through the body. But as it induces cold 
rather than warmth, it does not increase the resistance as much 
as does wine. 



THE CAN ON OF MEDICINE 315 

12. The Effect of Sleep and the Act of Waking on the 

Pulse 

587. The characters of the pulse during sleep vary according 
to the stage of sleep and the state of digestion. 

At the_ beginning of sleep, the pulse is small and weak, 
because the innate heat is then in process of retracting and with- 
drawing inwardly,* instead of expanding and travelling to the 
surface. 

588. Difference between the " heat " in the first stage of 
sleep and that produced by exercise. — During the time of sleep, 
the innate heat is withdrawn inwards by the vegetative faculty 
in order to procure the digestion of the aliment and the matura- 
tion of effete substances. The heat is therefore, as it were, 

■ mastered and forced into service. The pulse is therefore more 
slow and sluggish in spite of the fact that the contraction and 
imprisonment of the heat in this region means a local increase 
of heat. For, in amount, this local heat is not so much as exists 
during the waking state, with its associated movements and 
exercise. 

_ Thus, exercise .is apt to create undue heat and " inflam- 
mation " up to an intemperamental degree, whereas there is 
only z moderate aggregation of heat when the. innate heat is 
imprisoned, and so " inflammation " is less feasible. You know 
that this is so, because of the fact that exercise makes breathing 
laboured (forced), and hurried, incomparably more than when the 
innate heat is constricted and imprisoned by some other agent 
similar to sleep. For instance, to be submerged in tepid water 
brings about such an imprisonment of innate heat, and produces 
rapid respiration, yet not nearly to the extent produced by toil 
and exercise. Careful consideration shows that nothing increases 
the heat as much as these do. But it is not the mere exercise 
which accounts for this, as if resting would bring about a ces- 
sation of heat production. It is rather that the heat produced 
by exercise simply moves on the breath to the exterior parts, 
as long as generation of the breath takes place. 

589. During the stage of sleep following the completion 
of digestion, the pulse becomes stronger. This is because vital 
power is added to by the digested aliment. The heat which had 
passed to the inward parts now returns towards the surface in 
order to regulate the nutrients passing thither, and also returns 
towards its source. This fact, and the fact that the temperament 

* i.e., into the abdominal viscera, in whose veins the blood has now collected. 



3 i6 THE CANON OF MEDICINE 

is made hotter by the products of nutrition explains why the pulse 
becomes of increased volume, and the arterial wall is softer 
because of the addition of the" appropriate nutrients. There is 
no increase in swiftness and briskness along with the increase 
of volume, because mere increase of volume does not alter blood- 
pressure (lit. increase the resistance) either directly or indirectly ; 
that is, by restoring the factors which directly raise the blood- 
pressure (lit. increase the resistance). 
r * * * 

The thought underlying this passage may be expressed as 
follows : — The 'person is supposed to have gone to sleep shortly 
after completing his meal. The body-heat is now concentrated 
round the digestive organs in order to render digestion possible. 
The surface of the body becomes cold. Later, when the first 
digestion is accomplished, the products are distributed_ to the 
various parts of the body. The heat now leaves the interior 
parts (i.e. the splanchnic system), and may be pictured as 
passing to the surface again, whence it had come (mabda'), so as 
to be ready to receive these digestive-products. Once more 
does it preside (lit. regulate, tadblr), or brood over them so as to 
render possible the further (third and fourth) digestion which 
they are about to undergo in this new situation. 

The pulse is strengthened by two factors : (a) the access of 
body-heat which has now left the abdomen ; (b) the food-products. 
The latter affect the pulse in two ways : (i) indirectly, by making 
the temperament more hot ; (ii) directly, by making the arterial 

wall soft. 

The person, it will be borne in mind, is supposed to be 
still sleeping. If he continues to sleep, the pulse will change 
in the manner next to be described ; if he awakes, the conditions 

also change, and the pulse alters as described below. 

* * * 

590. If sleep continues after the completion of digestion, 
the pulse again becomes weak owing to the aggregation of innate 
heat and the choking of the vital power by the undue prepon- 
derance of those effete substances which now await evacuation by 
channels only possible during the waking state — namely exercise, 
and the insensible perspiration. 

591. If the body were fasting when sleep began, and there 
is nothing awaiting digestion, the temperament would tend to- 
wards coldness, and consequently the pulse would not only 
remain small, slow and sluggish but would become more so. 

592. The act of waking has certain effects on the pulse. 



THE CANON OF MEDICINE 3n 

When a sleeping person awakes, the pulse steadily gains volume 
and swiftness until it "reaches the natural state fVthat person. 
But if the^ wakening is sudden, the change in the pulse will be 
sudden ; it will become rapidly weak, because the act of waking 
overrules the vital power. The previous large volume will 
reappear later, and the pulse will become quick, brisk and 
irregular (up to "thrilling"). The quasi-violent movement 
introduces great heat. The sudden stirring up of the vital power 
to meet the sudden change accounts for the irregularity and 
trembling of the pulse. _ However, the pulse does not remain 
long m this condition ; it rapidly becomes regular again. 
Seemingly potent though the agent 'is, its duration is so short 
that all trace of its effect is soon lost. 

13. The Pulse during (rigorous) Athletic Exercise 

Note : the word " Exercise " includes (a) athletic sports of all kinds : running 
endurance tests, sprinting, gymnastics of all kinds, military exercises, laborious 
manual or physical work ; (b) work in the fields ; (c) necessary exercise and walking 
exercise taken for health's sake and recreation ; (d) mental. 

593. _ At the outset, as long as the exertion is moderate, 
the pulse is large and strong. This is because the innate heat 
increases, and is strong. The pulse is also swift and brisk. This 
is because the resistance becomes greatly increased by the 
exertion. 

(The pulse is frequent, strong, and the artery is moderately contracted : 115 ) 

594. As exertion continues and increases, even if it be 
intense for only a short time, the pulse weakens, and, with the 
dispersal of the innate heat, becomes small. The pulse remains 
swift and brisk for two reasons : (1) the degree of resistance 
(i.e. blood-pressure) is further increased ; (2) the vital power 
progressively fails until it is insufficient. After this, the swiftness 
steadily and progressively lessens ; and the briskness increases 
correspondingly to the lessening of vital power. 

(Violent, but not excessive exercise, renders the pulse frequent, strong sudden 
vehement, large, short, dicrotous : * 1 5 ) 

Still further prolongation of the exertion weakens the. pulse 
until it becomes formicant and very brisk. 

(Exhaustion produces a frequent, sudden, short, not vehement, very dicrotous 
pulse. It is large unless the heart is very weak. Fatigue makes the pulse slightly 
slow; the force is diminished, the arteries are relaxed. 115 ) 

595. Finally, if the exercise has been carried on to an 
extremely excessive extent, it leads to a state akin to death, acting 



3 i 8 THE CANON OF MEDICINE 

like all resolvents— that is, it renders the pulse vermicular, very 

brisk, slow, weak and small.^ 

14. The Effect of Bathing on the Pulse 

596, (1) Hot bath. If one bathes in hot water, the first 
effect is to make the pulse strong and raise the pressure. When 
the bath has brought about a dispersal of the vital power, the 
pulse becomes weak. Galen says it is small, slow m beat and 
sluggish. But while agreeing that it is weak and small ; we 
say that the hot water acts first by increasing the interior heat 
of the body, like any extraneous heat, i.e. only temporarily. 
After a while the water resumes its cooling effect* — its natural 
quality. This cooling effect may persist. As long as its action 
as extraneous heat holds the field, the pulse becomes swift and 
brisk. But when its own natural character is resumed, the pulse 
will be slow and sluggish. If the incidental quality (of being hot) 
lead to so much loss of strength that syncope is imminent, the 
pulse becomes slow and sluggish. 

(2) Cold baths. If the cold reaches to the interior parts, 
the pulse becomes weak, small, sluggish, slow. If it does not do 
so but has the effect of aggregating the innate heat in the 
interior, the volume of the pulse will increase as the power 
increases, and the swiftness and briskness decrease. 

(3^ Bathing in natural thermal waters. If these have desiccant 
properties, the pulse becomes harder and its volume diminishes 
If they impart warmth, the swiftness increases. _ If they dispel 
the vital power the pulse will come to be as described above. 

15. The Pulse in Pregnancy 

597. The resistance is specially great in pregnancy, because 
the foetus shares in the mother's respiration. Both mother and 
embryo have their own resistance (blood-pressure), and there is 
as it were a double respiration. Nevertheless there is no doubt 
about the fact that the vital power is neither increased nor 
lessened, except to a degree consistent with a slight lassitude 
proceeding from the mere weight of the foetus. Hence the in- 
crease of resistance overrules the moderate amount of vital 
power, and the pulse is made of greater volume and becomes 
swift and brisk. 

8 «6 The Chinese say : a pulse at C which is constantly superficial (or 
" swimming "for deep in an Otherwise healthy woman, with arneuorrho^, b<^ 
pregnancy? so also a high strong C pulse ; a slippery pulse at C is a certain 

* On the nervous system. 



THE CANON OF MEDICINE 319 

sign. An overflowing and high or deep and full pulse at the left C goes with a male 
pregnancy ; a superficial and high pulse at the right C betokens a female pregnancy. 

A number of other rules are given, the changes in the character of the pulse 
during the successive months of pregnancy being specified. Thus, first month : 
W pulse small, C pulse brisk. Third month : pressure with the finger makes the 
pulse seem to disperse. Sixth month : pressure does not alter the typical character. 
Seventh-eighth month : full, hard, strong pulse betokens a good labour. A deep 
and slender pulse forewarns of difficult labour. 

Death of the foetus makes the pulse long and tremulous. 

If the C pulse is continually small, weak, and sharp, and the nature is cold, \ 
with a tendency to shiverings, pregnancy will never be possible. 

16. The Pulse in Pain 

598 e Pain changes the character of the pulse according to 
(1) its intensity ; (2^ its duration ; (3) its situation — whether 
the member affected is a vital one or not. 

At first, pain stirs up the vital power, making it resist and 
counteract the pain ; at the same time the cause of the pain 
increases the heat of the body. The pulse is therefore of large 
volume, swift and very brisk, the effort entailed in immobilizing 
the body [the reflex effect of the pain] accounting for the volume 
and swiftness. When the pain becomes less unbearable in one 
or other of the ways we have already explained, the pulse steadily 
declines in fullness until it has lost its size and swiftness ; but 
these features are replaced by very marked briskness and small- 
ness of beat, and hence the pulse becomes formicant and ver- 
micular. 

If pain becomes more and more severe, it makes the pulse 
sluggish and finally extinct. 

17. The Pulse in (Inflammatory) Swellings 

599. The formation of certain swellings is associated with 
fever, either because of their size, or because they affect some 
vital organ. The pulse varies with the changes induced in the 
body as a whole by the fever, as we shall explain in its proper 
place. 

Afebrile swellings alter the pulse of the member itself, from 
their very nature. The pulse in the rest of the. body may be 
altered secondarily — not because they are swellings, but because 
they produce pain (and restrict movement. Aeg.). 

In sthenic fever, the pulse is frequent, sudden, vehement, large, short, 
dicrotous. In asthenic fever it is frequent, sudden, not vehement, large (unless the 
heart is weak), short, and very dicrotous. In peritonitis, the arteries are extremely 
contracted. (Broadbent.) 

600. When an inflammatory mass causes a change of the 
pulse, it does so either according to (1) kind of swelling, (2) its 



3 2o THE CANON OF MEDICINE 

phase, (3) its bulk, (4) the organ in which it occurs, (5) associated 

effects. .,,,,, 

1. Relation to variety of mass, {a) If ' hot,_ the pulse 
becomes harsh, and coarsely, and then finely thrilling ; swift, 
brisk. (b) If, however, there is an antagonistic humectant agent 
at work, the pulse ceases to be harsh and becomes undulatory. 
It is also always tremulous — coarse or fine tremor — and swift 
and brisk. Not only are there agents which will alter a hard 
pulse,' but there are also agents which make a harsh pulse more 
decided, (c) If the mass be soft, the pulse is undulatory. 
(d) If very cold, the pulse becomes slow and sluggish, (e) If 
hard, the harsh pulse becomes still more harsh. 

When abscess formation comes on, the pulse ceases to be 
harsh and becomes undulatory. This is because suppuration 
goes with moisture and softness. The pulse also becomes 
irregular owing to the weight of the mass, and the rate of brisk- 
ness lessens owing- to the" fact that heat-formation ceases with 
maturation of the pus. 

2. Relation between phase of inflammatory process and 
character of pulse. The larger the " hot " inflammatory mass 
becomes, the more harsh does the pulse become. The hardness 
and tension in the mass increases steadily, and as the pain in- 
creases, tremor appears in the pulse. At the acme, all the 
features of the pulse become more marked, except those depend- 
ing on force ; the force of the pulse lessens and the briskness 
and swiftness increase. If the acme is prolonged, the swiftness 
lessens and the pulse becomes formicant. After the swelling 
subsides, whether by natural processes or by surgical interference, 
the pulse becomes strong in proportion as the tension in the 
swelling lessens ; and the pulse ceases to be thrilling because 
the pain ceases with the fall of tension in the tissues. 

3. Relation between bulk of inflammatory ^ mass and the 
pulse. A large mass denotes marked inflammation ; the pulse 
becomes larger in all respects, and each beat is prolonged. 
When the mass is only small, the pulse is smaller and more 

sluggish. 

4. Effect of the position in the body. When the inflam- 
matory process is situate in an organ or tissue rich in sensory- 
nerves, the pulse' becomes hard, and approaches the "harsh" 
type. If the organ is rich in blood-vessels, there is an increase 
in size of the pulse, and in force ; and it is very irregular. If 
arteries predominate — as in the spleen and lung — the volume 
is not maintained unless the force is maintained as well. 



THE CANON OF MEDICINE 321 

When it is situate in moist soft members (like the brain 
and lung) the pulse becomes undulating. 

5. Effect of secondary results of inflammation. An inflam- 
matory mass in the lung has a choking effect, and hence the pulse 
becomes thrilling • in the liver, atrophy is produced and the 
pulse becomes like that found in wasting diseases ; in the kidney, 
strangury is produced, and there is suppression of urine, which 
alters the pulse accordingly. In members which are rich in 
sensory nerves (stomach, diaphragm), the pulse becomes 
spasmodic and swooning. 

18. Effect of various Emotional States* on the Pulse 

601. Anger. Anger stirs up the vital power and causes 
the breath (ruh) to expand all at once. Hence the pulse is large, 
rises high, is swift and brisk. It is not necessarily irregular 
because the passion does not change — unless there is fear present 
as well, in which case anger would prevail at one time, and fear 
at another. Irregularity may also occur if shame is associated, 
for the intellect warns the person to be silent and not yield to 
the same evil as did the person who has excited one to anger. 

Excitement apart from anger.— The pulse is frequent, strong, and the artery 
is moderately contracted. — Note also the modern observation that " excitement 
always increases the blood-concentration, sometimes by as much as 10 per cent "" 
(Barbour and Hamilton, Journ. Am. Med. Assoc, 1927, p. 91). 

Delight. Here the movement is gradual and outwards. 
The pulse does not become as speedy and brisk as in the case of 
anger, but its volume is adequate for the resistance, and therefore 
the pulse is slow and infrequent. 

Joy. The pulse is similar to the preceding, because usually 
large in volume, and soft ; it becomes slow and infrequent. 

Grief. Here the heat is extinguished, or choked, nearly to 
obliteration, and the vital power is weakened. Hence the pulse 
is small, weak, sluggish and slow. 

Fear. If of sudden origin, the pulse becomes quick, 
irregular, disorderly. If the state is prolonged, or more or less 
habitual, having begun insidiously, the pulse varies with the 
varying shades of anxiety. 

Love.— " Now the lover's pulse is variable and irregular, especially when he 
sees the object of his affections, or hears her name, or gets tidings of her. In this 
way one can discover, in the case of the one who conceals his love and the name of 
his beloved, who is the object of his passion. . . ."— (Dhakhira-i-Khwarazm-shahi, 
Book vi. Guftar 1, Juz' 2, ch. 3 ; E. G. Browne's translation,' p. 89.) 

* Nafsaniat. See § 160 hi, iv, and 174 sqq. 



322 THE CANON OF MEDICINE 

19. Brief Summary of the Changes produced by Agents 

ANTAGONISTIC TO THE NATURE OF THE PuLSE 

602. When the pulse is changed by such agents, it is 
either (1) because of an intemperament ; and you know the effect 
of each of these upon the pulse ; or (2) by confining the vital 
power, whereby the pulse becomes irregular. If the restriction 
be unduly great, the pulse becomes also disorderly and arhythmic 
The degree of confinement varies with the amount of morbid 
material, whether there be an inflammatory mass or not. Or, 
(3) b y dispersal of the vital power, whereby the pulse becomes 
weak. Here belong such agents as : severe pain, affections of 
the mind which produce a profound loss of vital power, severe 
or protracted diarrhoea. 

8 2^7 Pulse in convalescence from acute disease : the rate is normal or slightly 
slow -the force of the heart is diminished and the arteries are relaxed The force 
of the heart and the arterial tone increase as convalescence advances. (Broadbent, 

P ' 5I The " renal pulse " : the frequency is normal or slightly diminished. The 
force of the heart beat is increased. The arterioles are contracted (ib.). 



THE URINE 



i. General Remarks 

Precautions necessary in Collecting the Urine, before 
Forming an Opinion as to its Character 

603. i. It must be collected in the early morning* ; it 
must not have been kept over from the night before.f 

2. The person must not have taken either food or drink 
before passing it. 

3. _ The previous food must have been free from colouring 
agents like crocus and cassia fistula (these render the urine lemon 
yellow or ruddy), and from potherbs (which make the urine a 
greenish tint), and from salted fish (which renders the urine dark), 
and from intoxicating wines (which tend to render the colour 
of the urine similar to themselves). 

4. The patient should not have been given an agent which 
expels some humour (a cholagogue or phlegmagogue) by the 
urine. 

5. Physiological state. The patient should not have under- 
taken severe exercise or toil, or be in a praeternatural mental 
state ; for in each case the colour of the urine may alter. E.g., 
fasting, wakefulness,f toil, anger, dread — for all these cause the 
urine to become more lemon-yellow or redder in tint. Coitus 
also alters the urine, rendering it oily. Vomiting and defecation 
alter both colour and texture of the urine. The same happens 
if the urine is kept standing a while. This is why some advise 
urine not to be left standing more than six hours before exam- 
ination, for otherwise the significance is altered ; the colour 
changes; the sediment goes partly into solution ; and the 
density increases. Personally I think that such changes begin 
within an hour. 

6. The whole of the urine should be collected into one 

* Because digestion, whose efficacy the urinoscopy determines, will then have 
had time to be completed in a normal person. 

f The patient must have slept through the night. 

323 



324 THE CANON OF MEDICINE 

single vessel lest anything should be spilt out of it ; one should 
allow it to settle before scrutinizing it. 

7. The urinal must be clean. For instance, alkanna will 
impart its colour to the urine ; this is a dye used by some 
people for tinting their skin and finger-nails. 

8.. The vessel used for the specimen must be clean, and 
the previous sample must have been rinsed out of it. 

9. The material of which the vessel is made should be 
clear white glass or crystal. 

10. The urine must not be exposed to the sun or wind 
or freezing cold, until the sediment has separated out and the 
various characters have properly developed. The settling is not 
immediate even if the digestive processes are normal. 

11. The sample must be inspected in a light place where 
the rays do not fall directly upon it, as otherwise the brilliant 
light would interfere with the colours and give rise to erroneous 
deductions. 

12. The nearer one holds the sample to the eye, the denser 
does it appear. The further away it is, the clearer does it seem. 
In this way one can distinguish urine from other fluids brought 
to the doctor in a falsified state. 

604„ There is little advantage to be derived from the study 
of the urine in childhood, and still less in infancy, because their 
nourishment consists solely of milk, and the very little colouring 
matter there is in the urine is lost to view ; their " nature " is 
also very feeble in view of the fact that they pass so much time 
in sleep, which abolishes the evidences of digestion. 

805o The first and foremost object of observing the urine 
is to form an opinion about the state of the liver, the urinary 
passages and the blood-vessels. The various disorders of these 
organs are revealed by it. But the most precise information 
to be obtained is that concerning the functional capacity of the 
liver. 

Inspection of Urine, (tafsira.) 

The name " tafsira " is given to " inspection " because it " explains " (tufassir) 
and makes manifest to the physician ; it is an indication or guide (dalll) to the 
patient's condition.* 

606, The following are the points to observe in a 
sample of urine : 

1. quantity (665) 

2. odour (645) 

* Diet, of the Technical Terms used in the Sciences of the Mussulmans 1I8 , and 
Browne ', p. 142. 



THE CANON OF MEDICINE 325 

3. colour • (609) 

4. foam (649) 

5. texture (627) : 

6. clearness (632) 

7. sediment (652) 

Some persons add other two : the feel and the taste, but 
we reject them as objectionable. 

By colour we understand the various shades of colour 
perceived by the sense of sight — whiteness, darkness, inter- 
mediate shades. 

By texture we refer to the coarseness or fineness. 

By clearness or turbidity we refer to the ease or otherwise 
with which light traverses it (translucence). 

607. There is a difference between texture and trans- 
lucence, for a urine may be coarse and yet as .clear as egg-white 
or liquid fish-glue ; and a rarefied urine may be turbid (e.g. 
turbid water is more rarefied than white of egg). 

608. Turbidity depends on the presence of certain vari- 
ously coloured particles — opaque or dark, or tinted with other 
colours which are imperceptible to the sense of sight and yet are 
impervious. Sediment differs from turbidity in that the particles 
are readily visible to the eye, whereas particles cannot reallv be 
distinguished in the case of turbidity. Sediment appears imme- 
diately after the passage of the urine ; turbidity does not clear 
up on standing. Turbidity differs from coloration in that the 
latter pervades the whole substance of the urine, whereas tur- 
bidity is less intimately admixed. 

1. The Significance of the Colour of the Urine 

609o The degrees of yellowness. Among the shades 
of yellow colour are : (1) straw-yellow ; (2) lemon-yellow;* 
{3) orange-yellow ; (4) flame-yellow, or saffron-yellow ; that 
is, a very deep yellow ; (5) clear reddish-yellow. All except 
the first two denote a hot in temperament, in degrees varying 
with the amount of exercise, pain, fasting, and abstinence from 
water. The fourth variety denotes predominance of the bilious 
humour. 

[Variants of (i). If the urine is plentiful also, it shows that a crude humour 
is being excreted by the urine. If there is also a sediment which is white, smooth, 

* Lemon-yellow (utruj). — Orange-yellow (narahja). — Reddish-yellow (shuqrat). 
— The latter is the yellowish colour of a chestnut horse. — Another yellow, with a 
areddish shade, is called jujube colour (unnabi) ; this is not in the text, though 
■enumerated with dyers' colours (cf. Night 933). 



326 THE CANON OF MEDICINE 

equable and plentiful, it shows that the digestion is good. If thicker, and a sediment 
is present, it shows that the digestion is not altogether bad. If gritty, scaly, fur- 
furaceous, with black, livid, green or fetid sediment, this shows entire lack of diges- 
tive function (Aegineta).] : - 

610. II. The degrees of redness, (i) rose-red or roseate ; 
(2) very dark red ; (3) purple red, which has a brilliance about 
it like a certain rose ; (4) smoky red or dull red. All these 
denote dominance of the sanguineous humour, for dullness, 
of colour points that way. A flame-yellow shows the presence 
of more " heat " than dull red because it shows there is bilious 
humour in it, and this is hotter than sanguineous humour. 

The urine tends to saffron-yellow and flame-yellow in acute 
maladies described as " burning " ; but if the urine is at all 
inclined to be clear, it shows a certain degree of " digestion," 
namely that this process has actually begun, but its products 
have not yet appeared in the substance of the urine. 

611. ' Deepening of colour from lemon-yellowness towards 
a flame-yellow shade shows that the innate heat is steadily- 
increasing. The colour then ceases to be yellow, and attains a 
pure clear red. If the urine now begins to clarify it shows that 
the (pathological) heat is beginning to subside. 

In acute diseases of a haemorrhagic character, the urine 
may be tinged with blood without any evident rupture of blood- 
vessels having occurred. This would indicate an _ excessive 
plethora. A gradual loss of blood by the urine, associated with 
a bad odour, is a sign to be dreaded because it informs us that 
there is haemorrhage proceeding from congested parts. The 
prognosis is still worse if the urine becomes thinner and more 
offensive in odour. 

612. Admixture of the urine with blood may be a good 
sign — namely in acute composite fevers — for it shows that 
crisis is about to take place, and recovery will follow. The only 
exception is if the urine becomes suddenly transparent (its colour 
becoming normal, i.e.) before the crisis is due. Such a phenome- 
non would be a forerunner of a relapse. But thin urine appearing 
before the crisis may be equally unfavourable unless the change, 
has been gradual and progressive. 

613. In jaundice, if the urine becomes of a deeper red 
until it is nearly black, and its stain on linen can no longer be 
removed, it is a good sign ; — the better the deeper the_ red.. 
But if the urine becomes white or slightly reddish, and the jaun- 
dice is not subsiding, the advent of dropsy is to be feared. 

Fasting is among the conditions which render the urine- 
high-coloured and of marked acridity. 



THE CANON OF MEDICINE 327 

614. III. The degrees of green colour, (i) A colour 
approaching that of pistachios* ; (2) the colour of verdigris ; 
(3) rainbow green ; (4) emerald green ; (5) leek-green. The 
first denotes a cold intemperament, as do all things the shade 
of whose green is not (2) or (5). These (2, c) denote extreme 
combustion, but (5) is not as unhealthy as (2). If it should be 
met with after- physical labour it denotes " spasm." A green- 
coloured urine in adolescence points to the same condition. 

Rainbow green usually denotes an extremely cold intem- 
perament. In this respect it comes next to (1). Some say 
that it shows that poison was present in the fluid taken as drink, 
and that if there be a sediment present there is a hope of recovery; 
if no sediment, death is likely to take place. Verdigris green 
colour of urine forewarns of death (destruction of innate heat). 

615. IV. The degrees of blackness. (1) Dark urine ap- 
proaching blackness, through a saffron colour. This occurs in 
jaundice, for instance. It denotes (a) denseness and oxidation of 
the bilious humour ; (b) atrabilious humour derived from 
bilious humour ; (c) jaundice. (2) Deep-brown-black. This 
shows the presence of sanguineous atrabilious humour. (3) 
Greenish-black. This shows the dominance of pure atrabilious 
humour. 

(Speaking generally) dark or black urine denotes (a) extreme 
oxidation ; (J?) great cold ; (c) extinction of the innate heat 
(i.e. death) ; {d) crisis ; (e) evacuation whereby the effete sub- 
stances from the atrabilious humour are expelled. 

616. (The details about each of these are :) (a) dark urine 
due to extreme oxidation is recognized by its causing scalding, and 
being previously yellow or red. The sediment is discrete (not 
coherent), not homogeneous, discontinuous, not very dark, 
but tending to a saffron, lemon-yellow, or dark brown." If the 
colour of the sediment tends to be lemon-yellow, it strongly 
suggests jaundice. 

(b) When darkness of the urine is due to great cold, the 
urine would previously be tending to a green tint or a livid tint. 
The sediment is here slightly coherent, and looks dry, and is 
more purely black in colour. If a dark urine is also very offensive, 
it shows that the temperament is hot. If it be odourless, or has 
only a slight odour, it shows that the temperament is cold. This 
is because no odour emanates from urine unless the innate heat 
overrules the cold. 

* Cf. the passage in Night 933 : " I can dye various kinds of green, such 
as grass green, olive green, pistachio green, parrot green." (Burton, v. 483.) 



328 THE CANON OF MEDICINE 

(c) When darkness of urine is due to extinction of the innate 
heat this is recognized by the dispersion of vitality. _ 

(d) When the darkness arises from a critical change in a tever 
(" critical polyuria") one of the following conditions may be 
supposed : the termination of a quartan fever ; the resolution 
of a splenic disease ; the termination of a fever associated with 
the atrabilious humour ; the termination of a fever prevailing 
by night and by day ; subsidence of pains m the back and 
womb ; retained menses ; retained blood in a case of piles—both 
the latter two occurring especially when nature is assisted by art. 
It occurs in women in whom the menses are retained, because the 
effete matters of the blood cannot be disposed of by nature This 
is shown in the urine by its being watery previously. VV hen the 
effete matters are finally discharged from the body, the urine at 
the same time becomes very abundant. ^ 

617 Prognosis. If at the critical periods the urine do not 
become dark, it is an ominous sign, especially in_ acute diseases 
the more so if at the same time (a) the quantity ol urine be small 
(for scanty urine is evidence that the humour has already become 
destroyed by oxidation) ; (b) the sediment be coarse-textured ; 
the coarser, the more depraved ; the finer, the less. 

Dark urine is a good sign in acute diseases. _ _ 

If the urine is limpid [as well as dark] and a deposit is 
suspended in it at different layers, this denotes cephalalgia, wake- 
fulness, deafness, mental confusion. If the urine is secreted 
only by drops, and a sediment forms slowly, and the odour is 
pungent, and there is fever— all this would be strong evidence 
of the above. But when there is wakefulness, deafness, delirium, 
and headache— such-urine would show that epistaxis is pending. 

Dark or dull red urine which is passed after drinking wine 
of that colour or after taking certain medicines need cause no 
alarm. The wine has simply passed unchanged through the 

° Dark urine may be evidence of renal calculus. As Rufus 
says " black urine is good in infirmities of the kidneys and in 
stone in the bladder, and also in maniacal cases, for they are 
diseases proceeding from gross humours. But it is a grave sign 
in acute diseases": On the other hand, he says that blacK urine 
is a bad sign in diseases of the kidneys and bladder if at the same 
time it is extremely scalding. Therefore one must take all such 
signs into consideration. . . 

When dark urine occurs in aged persons, it is not a good 
sign because in such persons, as you know, it can only denote 



THE CANON OF MEDICINE 329 

great destruction oftissue. In puerperal women, the appearance 
of dark urine is premonitory in convulsions. 

In brief, the appearance of dark urine is serious at the onset 
of fevers as well as at their close, if there is neither crisis nor any 
abatement of symptoms at the same time. 

618. White urine. The word " whiteness " is applied 
in two ways : mere translucence, as the laity calls anything which 
is translucent " white." Thus, clear glass, clear crystal, are 
" white." Translucence implies absence of all colour. Such 
urine is " thin " and translucent. Secondly, there is true white- 
ness, like that of milk or parchment. Such urine is not trans- 
lucent. 

Whiteness in the first sense shows that the intemperament 
is altogether a cold one, and that digestion is good. If the urine 
be at the same time coarse, it shows that the serous humour is 
abundant. A urine which is white in the second sense is neces- 
sarilv coarse. 
'619. 



Variety of Whiteness. 



(a) Mucilaginous. 

(b) Waxlike. 

(c) Greasy, soapy. 

(d) Musty whiteness : 

(i) Tinted with blood and pus. 

(ii) Not tinted with blood. 

(e) Semen-like : 

(i) Critical in form. 



(ii) Not critical in form and no 
inflammation. 

(iii) Continuous throughout a fever. 
{/) Lead-white ; no sediment. 
(g) Milk-white ; in acute diseases. 
(h) Previously coloured ; in acute fevers. 



(i) Sudden change from red to white in 
the course of a fever. 

(j) Whiteness persisting in a person ap- 
parently healthy. 

(k) Whiteness like buttermilk, in acute 
fevers. 



Significance. 



Excess of serous humour, and crude 

humour. 
Liquefaction of adipose tissue. 
Liquefaction of serous humour ; or it 

may denote diabetes, active or latent. 

Ulcers discharging into the urinary 

passages. 
Great excess of crude non-matured 

matter ; vesical calculus. 

Crisis in an inflammation arising in 

serous humour. 
Diseases associated with vitreous serous 

humour. 
Seminal emission. 
Forewarns of apoplexy and palsy. 

The fever will soon become quartan 

Bad. 

Ominous. 

This shows that bilious humour has 
descended to some member about to 
develop an inflammation (e.g., the 
abdomen, or, which is worse, the head) . 

The patient will become delirious. 

Absence of digestion (esp. in the venous 
system : Ch.M.') ; and in diabetes. 
Fatal issue ; or wasting. 



620. When the intemperament is hot because of the 
dominance of the bilious humour, the urine may appear white 



33 o THE CANON OF MEDICINE 

[contrary to expectation]. When the intemperament is cold 
because of dominance of ,the serous humour, the urine may 
appear red [contrary to expectation]. If the bilious humour 
passes down the urinary passages without being admixed with 
the urine, the latter remains white. Hence it is necessary to 
study white urine with care. For, if its colour were brilliant, 
and 'if the deposit is plentiful and coarse, and the urine itself is 
rather thick, it shows that the whiteness arises from a cold 
intemperament, with predominance of the serous humour. 
Again, if the urine be not clear and bright, and there is not much 
deposit, and if the whiteness tends to a brownish tint, it shows 
that there is bilious humour concealed therein. Whiteness in 
the course of an acute disease, the signs of recovery being 
present, with no fear of maniacal delirium, and the like, indicates 
that the bilious humour has passed outby some other channel, 
such as the intestine, causing constipation. 

Brilliant.— Arabic ; mushriq ; Latin: clarus.— This term 
describes the colour-effect produced in urine by the presence ot 
bile-pigment (as shown by its use in the next paragraph, where it 
is evidently equivalent to our " dichroic "). Other equivalents are : 
bright, shining, refulgent, lustrous, luminous. In this passage 
Avicenna seeks to warn the reader that a urine is not necessarily 
free of " bilious humour " because it happens to be very pale (white). 

Brilliance, however, may be taken as evidence of health, tor 
when metabolism proceeds quite normally, the urine assumes a 
peculiar clear shining colour when viewed in the light. In this case, 
we may think of the various stages of catabolism proceeding without 
the formation of irregular intermediate substances, or by-products. 
The moments of nascence (§91) are " sharp " throughout. 

621 If urine is red in the course of " cold " maladies, 
it means'one of four things— (1) that there is severe pain which 
disperses the bilious humour (ex. : colic without the signs ot 
inflammation) ; (2) there is so much serous humour in the 
bileducts as to give rise to obstruction there, and the bilious 
humour is in conseqiience diverted from the intestine into the 
urinary passages. (3) Hepatic insufficiency, especially m regard 
to separating off water from the blood, as occurs in cold 
dropsy. The urine comes to look like the washings of raw meat. 
(A Some form of putrefactive process in the veins subsequent 
to obstruction in the ducts ; here the serous humour in the 
vessels undergoes a change of colour. The urine is rendered 
watery, and the sediment is of a kind already described- 
faint in colour, and not refulgent. _ The presence ot bilious 
humour renders a colour refulgent (i.e. dichroic). 



THE CANON OF MEDICINE 33 t 

622. Urine is often white at the onset of a disease, and 
becomes dark and offensive in odour later. So it is in jaundice. 

623. Urine becomes White after a meal, and remains so 
until digestion is nearly completed. It then begins to assume 
colour. 

624. During the waking state, the urine is white—partly 
because of dispersal of the innate heat — but it is not refulgent. 
It tends to be dusky if there is an associated defective digestion. 

625. Prognosis. A red colour is better than ' a watery- 
white one, in the case of acute diseases. But a white colour 'is 
better if intrinsic — not due to wateriness. 

Redness due to blood is not as dangerous as redness due 
to bilious humour. Redness from bilious humour is not as 
serious if the bilious humour is quiescent ; it is very ominous 
if it begins to move about. 

Red urine is very bad in the case of renal disease because it 
is a sign that there is a " hot " inflammatory process there. If 
it occurs m diseases associated with (intense) headache, it por- 
tends delirium. 

When a urine begins to turn red in an acute disease, and 
stays so,_ without forming a sediment, it is an ominous sign 
because it points to an inflammatory swelling in the kidneys. 
If such urine becomes turbid, and stays so, it points to an inflam- 
matory mass in the liver, with lack of innate heat. 

Unusual coloration of the urine, produced by eating saffron or cassia fistula 
must be borne m mind ; tricksters may alter their urine thus ( Alsaharavius) . 

So much for the simple colours of the urine. 

626. The compound colours of the urine. 

(i) Like raw meat washings (i.e. blood-stained water). 
This means hepatic insufficiency due to plethora of blood or 
to any form of intemperament, resulting in deficient digestive 
power and dispersal of the vitality. Were the vital power 
adequate, it would show that there is plenty of blood, even to 
great excess ; and in such a case, the secretory power would be 
hardly adequate for dealing with it. 

(2) Oleaginous. Oily. The fat of the bodv is being destroyed. 
The appearance is like a lemon-yellow tinged with" the green- 
ness of the mistletoe growing on larches. It is called oleaginous 
because it is viscid and translucent, and also has the lustre of fat, 
and shows a certain brilliance or refulgence in spite of a certain 
opacity. It is not a good sign in many states, "not to say it is 
bad. For it shows there is neither maturation, nor a change for 



332 THE CANON OF MEDICINE 

the better. In rare cases it indicates the critical evacuation of 
unctuous matter, but for it to mean this alleviation must follow. 
If such urine be also fetid and scanty m amount, it is a very 
ominous sign. It is also serious if it be admixed with material 
like meat washings, as might happen in the course -of dropsy, 
phthisis, .and intestinal obstruction. ... , . 

If oleaginous urine replaces a black urine, it is a good sign. 
But if such a urine appear on the fourth day of an acute disease 
it forewarns of the patient's death on the seventh day. (\ery 
dark oily urine forewarns of collapse and death. Theophilus) 

< In brief, there are three kinds of oleaginous urine (i) All 
fat, throughout. (2) Fat only in the lower part (3) Fat m the 
upper layers. The first is oleaginous only in colour ; it occurs 
in phthisis, hectic fever, and wasting diseases, especially at their 
outset The second is oleaginous only in substance. itie 
third is oily in both respects— e.g. m diseases or the kidney, 
at the acme and termination of phthisis. 

h) Purple {-black). This is a very bad sign. It means 
oxidation of both bilious and atrabilious humour 

(a) Ruddy colour admixed 'with a tinge of blackness. 1 ius 
occurs in composite fevers and in fevers arising from gross 
superfluities. If it clarifies, and the darkness settles down from 
the surface, it denotes an inflammatory .mass in the lung. 

3. The Signs afforded by the Density^ Quality, Clearness 
or Turbidity of the Urine 
627. Urine may be tiansparent or opaque, or intermediate 
in density. 

T , c .. Hp „ itv » h e r e spoken of is not the equivalent of "specific 
gr av^/ ?7 thouJh many "f 4e sSemTnts in the text would apply equally even m 
the modern sense. , h the morning and evening urine 

I need for depurative foods (greens, acid fruits). 

TRANSPARENT (LIMPID) URINE 

628 Whatever be the state, a urine of limpid consistence 
denotes : (a) deficient digestion (lack of maturation) ; {p) 
venous congestion ; (0 renal insufficiency (for the kidneys 
Inly separate, out fine matter, or if they attract other matter, 
they fail to discharge it until it has been rarefied or rendered capa- 
ble 7 of excretion ; \d) excessive fluid-intake ; (e) a very cold or 
a dry intern perament. 



THE CANON OF MEDICINE 233 

When it occurs in the course of an acute illness, it denotes 
deficient digestive power, . and inability to complete digestion 
(absence of maturation : cf. above). It may indicate that the 
weakness of the other faculties is so marked that they cannot 
influence water at all, and hence it passes through the body 
unchanged. 

629. Prognosis. It is worse for urine to be very transparent 
at puberty than in adolescence, because during the former period 
of life urine is naturally more opaque than in adolescence. Being 
more moist in their temperament, their bodies attract moisture 
more readily, and, in addition, moisture is essential for their 
growth. Hence, if acute fevers arise during the age of puberty, 
the urine is decidedly abnormal if it is transparent ; and, should 
it continue of that character, it would be a very ominous sign. 
Should it continue and favourable symptoms should not appear, 
and should the vitality not be maintained, it would be a sign 
that an abscess is forming below the liver. 

630. If urine continue to be transparent for a long time 
without any variation in a person otherwise healthy, should he 
experience pain one will know that an inflammatory mass is 
forming in the situation of the pain. The pain is usually lumbar 
when the urine is of this character, and that is the usual site for 
an abscess. 

If there is no localized pain in such a case, but a general 
pain and heaviness, this points to the widespread formation of 
small pustules. 

If the urine is transparent at the crisis of an illness, contrary 
to rule, it forewarns of a relapse. 

OPAQUE (THICK) URINE 

831. If the. urine is very opaque, it shows that maturation 
has failed to take place ; or, more rarely, it denotes the matura- 
tion of " gross " humours, such as occur at the height (status) 
of humoral fevers, or after the opening of abscesses. In acute 
fevers, the appearance of opaque urine is usually a bad sign, 
though not as bad as a persistently transparent urine. The fact 
that urine is opaque shows that there is a certain degree of diges- 
tion proceeding, because digestion adds to the opacity of urine 
to a certain extent, and shows that there is some power of expul- 
sion (of effete matter). But it is a bad sign in so far as it denotes 
the breakdown of, and abundance of, humours, and that the 
evacuation of the separated materials is hindered. 



334 THE CANON OF MEDICINE 

To ascertain which of the two is dominant, notice whether 
improvement or increased weakness follows. 

Prognosis. When opaque' urine is passed in the course 
of fevers, it is a less serious sign if it be poured out quickly and 
plentifully. When excreted slowly it denotes a redundance of 
the (serous, Ch.M. 7 ) humours and an enfeebled vitality. A sign 
which is still less serious is that a urine of medium density should 
go with a simultaneous improvement in the general condition. 

A very dense urine sometimes denotes that digestion is unduly excessive 
(Ch. M.'). 

When the urine is transparent in an acute illness, and then 
becomes thick, and there is no improvement in the condition of 
the patient, it denotes colliquation [of tissues]. 

Persistent opacity of urine in a presumably healthy person 
forewarns of fever should headache and mental confusion arise. 
Opaque urine also occurs after excessive evacuations, after the 
opening of an abscess, or owing to ulcers in the urinary passages. 

Transparent and opaque urine cannot both denote lack of 
digestion (maturation) unless there is an intermediate degree of 
density associated with the maturation. Dense substances are 
rendered thin or limpid by the process of digestion, and the urine 
changes from transparency to opacity. 

CLEARNESS AND TURBIDITY 

632. Thick urine, as has been already stated, is sometimes 
clear and translucent, sometimes turbid and opaque ; and yet 
there is a marked difference between thick and limpid translucent 
urine. When the former is shaken, it does not easily break up 
into little portions— it only forms large portions ; and the par- 
ticles move slowly ; and if it makes a foam, its foam is composed 
of numerous bubbles which do not coalesce for a long time. Such 
a urine is the outcome of an adequate digestion of the serous 
humour, or of the vitelline bilious humour (if there be any tint 
suggestive of yellowness in it) ; or of the resolution of vitreous 
serous humour (if there be not any tint of yellowness in it). 
The last-named variety is often found in the urine of epileptics. 

But a well-coloured transparent urine owes its colour not 
to digestion but to admixture with bilious humour. For other- 
wise digestion would be supposed to affect only the " substance " 
until a' mixture of colours had been brought about, whereas the 
process of digestion effects a change of " substance " first, and 
of colour secondarily. Digestion concerns " substance," not 
" colour." Hence if a transparent urine is yellow, and there is 



THE CANON OF MEDICINE 335 

no abatement of the acute illness, that is a bad sign, for it shows 
the digestive faculties are (dormant. 

_The^appearance of alternating redness and yellowness in a 
limpid urine points to inflammatory changes dependent on toil. 
If it be limpid and shows scale-like objects in it, and if the bladder 
is healthy, that is a sign of oxidation of the serous humour. 

In brief, a thick urine in acute febrile states may denote 
predominance of various humours, and at the same time point to 
colliquative processes (in the body). Should such processes 
persist during the whole phase of a disease, the urine would 
become more opaque (denser, thicker). 

Lastly, turbid urine denotes earthiness as well as the presence 
of gas _ and wateriness. For when these qualities are combined, 
turbidity is the result. -When they are separated again, the urine 
becomes clear. 

633, The following three states should be noted 

i. The urine is clear at the time of passing, and then 
becomes opaque. This shows that maturation is difficult ; that 
the matter (of the food) has not yet succumbed to the vegeta- 
tive powers (" nature "). It may denote colliquation in^ the 
tissues. 

2. The urine is opaque when passed, but then becomes 
clear. The coarse matters settle and separate out. This shows 
that the vegetative powers (" nature "fhave already overcome 
the material (of the food) and matured it. The clearer it grows, 
the_ greater the amount of sediment, and the more rapidly the 
sediment falls, the more complete is the digestion. 

3. A state between the above two. In this case the vege- 
tative powers improve, as long as the vitality is maintained. It 
shows that maturation is not progressing to completion. Rut 
if the vitality is not maintained, it would mean that the matura- 
tive processes are not likely to reach completion. Should this 
condition persist a long time without the feared symptoms (of 
loss of vitality) appearing, then it is likely that headache will 
develop, for it shows that there is much gas formation. 

In modern language we should say : — 

Urine which is clear when passed, but is turbid on standing ; if acid, the deposit 
SinL U rat ^ s ' wh ! ch f e *<* solub l e in the cold ; or (b) bacterial decomposition, 
stellar and triple phosphates separating out.— We should heat the specimen 
also , a cloud m an acid urine would be albumen _ 

brine which is turbid when passed or becomes turbid on standing ; if alkaline 
the deposit is earthy phosphates (magnesium and calcium). It is met wrS 
after a rich protein meal or vegetable meal. Such a urine may become 
cloudy on heating, from the deposition of (calcium) phosphates, which are 
soluble again if acetic acid be added. F 



336 THE CANON OF MEDICINE 

It is a better .sign for a clear urine to become turbid than 
for it to remain turbid for several hours after being passed. 

Urine may become turbid ^because of loss of vitality, apart 
from expulsion of " the nature." 

If urine is watery when voided, and remains so, it shows that 
digestion has entirely ceased. 

634, Good signs 

(a) Opaque urine easily voided, whose sediment falls easily : 
when occurring in palsy, etc. 

(//) Urine opaque when voided but then becoming trans- 
parent and plentiful. 

(c) Limpid plentiful urine following upon thick turbid 
urine or thick and scanty urine. 

(d) Opaque turbid urine passed at a slow rate, and then 
becoming suddenly abundant and easy to void. (This means 
that recovery is about to take place, whether it be an acute fever 
or any other plethoric disorder, or a plethora about to manifest 
as actual disease). But this kind of urine is rarely met with. 

635. If the urine is of natural colour, and its opacity be 
great, it is evident that much (effete) matter is passing through, 
and that there is no hindrance to their outflow. But it is usually 
a bad sign because it shows that the humours are superabundant, 
and the vitality deficient. Such a urine is scanty and difficult 

to void. . . . 

Opaque urine is a good sign if it occurs at the crisis in 
" splenic " diseases and " mixed " fevers, in which the emunctory 
powers cannot come into play, or equipoise be restored. 

Lastly, . turbid urine denotes that the humours are over- 
abundant and that the vegetative powers are inadequate for their 

digestion. 

636. Diagnostic points. Opaque urine, with a sandy sedi- 
ment, denotes calculus. Opaque urine, with pus, a bad odour, 
and scaly particles separating out, denotes rupture of an abscess. 
A thick urine, with the clinical evidences of an inflammatory 
mass or of an ulcer in the bladder, kidney, liver or chest, shows 
that there is an abscess about to burst. 

If the urine prior to that were like the washings of raw meat, 
it would show that there is unhealthy blood flowing from the 
liver ; and if the faeces were also similar, it would show there is 
an inflammatory mass in the interior of the liver. If prior to 
this there was shortness of breath, with a dry cough, and a 
stabbing pain in the chest, then one knows that an abscess has 



THE CANON OF MEDICINE 337 

ruptured which arose in the chest or (round the) aorta. If the 
pus is " mature," it is satisfactory. 

637. Discharge of urine resembling pus may benefit a 
person who takes no exercise and lives in an unhygienic manner. 
It clears the whole body, and removes the laxity resulting from 
the lack of exercise. It may be that there are obstructions in 
the liver andadnexa, and when the obstructions are removed, 
the urine which is voided is dense owing to the matter which 
passes out with it. Such " matter " is not " pus." It is only pus 
if it appears m the urine after the bursting of an abscess ; the 
urine is then not only thick but dark. If at this time there be 
pain m the left side, then one knows that the abscess was in the 
spleen. If the pain is in the upper part of the abdomen, one knows 
the abscess was m the stomach. The usual site for the abscess 
is m the hver and in the urinary organs. 

638. Turbid urine often denotes loss of vitality ; coldness 
dominates m the temperament as much as if the whole body 
were exposed to external cold. 

839. Turbid urine of the appearance of poor wine, or of 
chick-pea-water, may occur during pregnancy, and may be met 
with m persons with long-standing internal "hot" inflam- 
matory masses. 

640. Urine which has the extremely turbid appearance of 
asses urine or the urine of other cattle, arises from the very 
marked agitation which is going on in the humours, especially 
the serous humour, a certain amount of heat coming into play 
so as to set up that agitation. Hence this kind of urine is a fore- 
runner of headache or [coryzalj catarrh in the head. If it persists, 
it forewarns of lethargia. 

641 If the urine resembles the colour of some member 
for some time, it forewarns that disease is about to arise 
there. 

642. Some say that if the lower layers of the urine show a 
powdery or nebulous appearance, it means that the illness will 
be of long duration ; and that if it persists throughout the whole 
illness, it presages death, or the formation of " crude " serous 
humour, which is distinguished from pus by its fetor. 

643. If the urine separates into several layers, the more 
there are the stronger is the natural faculty, and the more open 
are the pores. ' r 

644. Threads floating in the urine denote that it was passed 
immediately after completing coitus. 



338 THE CANON OF MEDICINE 

4. The Signs derived from the Odour of the Urine 

645. Some people assert that no sick person ever passes a 
urine which has a healthy odour. But we say that if the urine is 
quite odourless, it denotes (a) a cold intemperament ; (b) exces- 
sive " crudity " ; (c) extinction of the innate heat, in the case 
of acute diseases. 

648, Fetid odour. A fetid odour, with signs of maturation lii 
the urine indicates ulcers in the urinary passages, or" scabies." 
These are identified from their own signs. If with the fetid odour, 
there are no signs of maturation, the cause of the odour may be 
merely putrefaction. 

Such a urine, in acute fevers, without disease in the urinary 
organs, is a bad sign. If it is present in acute fevers, and there is 
a tendency to acridity, it denotes putrefaction in humours which 
are of a cold nature, when there is a predominance of the extra- 
neous heat. . - 
If such a urine appears in acute diseases, it forewarns or 
' death by extinction of the innate heat and predominance of the 
pyfT"? n cons cold. 

'647, Sweetish odour. This denotes predominance of the 
sanguineous humour. If also very fetid, a predominance of the 

bilious humour. 

648, Putrid odour. If this tends to sourness it shows 
predominance of the atrabilious humour. 

An extremely fetid odour of the urine which continues in 
<;pite of seeming health denotes (a) that a fever arising from 
putrefaction is coming on ; (b) expulsion of retained putrescent 
matters. The latter will show whether the case may be expected 
to recover. If a fetid urine appears in an acute illness, and then 
suddenly ceases to be fetid, without subsidence of the symptoms, 
it shows a destruction of vitality. 

A moderately fetid urine denotes defective digestion : Haly Abbas. 

Offensive odour may be ammoniacal, as in alkaline fermentation Sweet 

odour may be " fruity » or like new-mown hay in diabetes. Specific odours result 
from the use of certain drugs. (Modern.) 

5. The Indications afforded by the Foam on Urine 

649, Foam arises from the moisture and the gases forced 
into the urine as it is passed into the urinal. The vapour which 
leaves the body with the urine doubtless adds to the consistence 
of the urine, especially if gases predominate in it, as occurs in 
cases of obstructions. The urine then shows many bubbles. 



THE CANON OF MEDICINE 339 

850. One notices the following points in regard to the 
foam : 

(1) Colour : it is dark or reddish in jaundice. 

(2) Size of bubbles : large ones indicate viscidity. 

(3) Number of bubbles : if numerous it denotes viscidity 
and much gas. 

(4) Rate of bursting of the bubbles : if slow, it indicates 
viscidity, and coarse glutinous humour. 

651. Prognosis. Hence if small bubbles persist in a speci- 
men, in cases of kidney disease, it shows that the illness will be 
of long duration. 

In brief, viscous humours in the course of kidney diseases 
are of bad omen ; they show that the humours are depraved, 
and cold in temperament. 

The significance of small bubbles has already been stated. 

6. The Indications derived from the Divers Kinds of 

Sediment 

852. Definition. In the first place one must specify the 
meaning of the term " sediment." It is not " that which sinks 
to the bottom of the vessel." It is " that whole substance (denser 
in essence than wateriness) which separates out from the wateri- 
ness — regardless of whether it settles down. or not, floats or not, 
sinks or not." 

Therefore we" may say that there are various characters 
pertaining to the sediment— its " structure," its quantity and 
quality, the arrangement of its components, its position, duration, 
and mode of permixture. 

I. STRUCTURE 

[Structure ; consistence ; texture.; essential substance ; 
matter ; jawhar.] 

A. NATURAL SEDIMENTS 

853. A sediment is natural, laudable, evidence of normal 
digestion and maturation, when it is white, sinks to the bottom 
of the vessel, when its particles are in continuity [i.e. not discrete], 
uniform, and all alike. In contour it is rounded. It is light, 
homogeneous, delicate, like the deposit which forms in rosewater. 

Its relation to the maturation of the various matters of the 
whole body is comparable to that to the maturation of pus. 
But whereas it is white, light, and of homogeneous nature and 
delicate in the former, in the case of pus it is coarse. 



34 o THE CANON OF MEDICINE 

654. A sediment betokens good digestion even though 
devoid of colour and homogeneity * But ancient physicians 
considered that homogeneity was a more important test than 
colour. A homogeneous deposit — even though not altogether 
white, or even if reddish in tint — is a better sign than a deposit 
which is white but not homogeneous, and composed of coarse 
particles. The sediment may or may not assume the same colour 
as the urine. If it does not,' it is better that it should be white, 
next best red, then lemon-yellow or saffron-yellow, and the least 
good is that it should be like arsenicum in colour, or of a colour 
like that of lentils. 

However, I counsel you not to regard what others say. 1 
say that — whiteness does not necessarily have a relation to the 
state of digestion ; homogeneity is always related to the (efficiency 
of) maturation. A thorough mingling of gaseous constituents 
will produce a white effect. 

If a sediment presents an unhealthy appearance, it is more 
favourable that it should be discrete than continuous. 

655. Good sediments resemble pus and crude serous 
humour when they are tenuqus. But pus is different in possessing 
fetor, crude serous humour is different in (rendering the deposit) 
compact and not homogeneous. A good sediment differs from 
both because it is finely textured and light. 

656. One would not expect to find such a deposit in a person 
who is healthy ; it occurs in the sick person because mattersare 
kept back in his blood-vessels, and they undergo (putrefactive) 
breakdown if they cannot be subjected to maturation. In health, 
the blood need not necessarily contain a humour which ought to 
be removed, but if there were such a humour present, it would 
be better if it were disposed of by way of the faeces (the indi- 
gestible excess in the aliments) than if it emerge by way of the 
urine as a sediment — whether such humour have undergone 
maturation or not. . 

In thin persons, the sediment of the urine is scanty and it 
sinks down differently according to the state of health, especially 
if the persons are accustomed to exercise or to practise laborious 

arts. 

The sediment is abundant only in obese persons ana in those 

of bad habits. 

657o Hence one does not expect to find as much sediment 
in sick persons who are lean as in those who are stout. For 

* The general significance of a sediment is that there is an excess of soluble 
or insoluble toxic substances in the blood. 



THE CANON OF MEDICINE 34I 

disease in the former often resolves without any sediment forming 
at all. At most there may be a tiny particle floating or swimmin^ 
in it. _ In other cases the sediment falls immediately after 
micturition unless there is good maturation—in which case 
very little deposit is to be expected. 

B. _ ABNORMAL SEDIMENTS 

658 Varieties, (i) Flaky or squamous ; (2) fleshy ; (>>) 
fatty; (4) mucoid or slimy; (5) purulent (ichorous) ; (6) hair-like- 
(7; resembling pieces of yeast infused in water ; (8) sandy or 
gritty ; (9) cineritial ; (10) hirudiniform. 

i. Flaky or squamous. This is composed of laro- e red or 
large white particles. They are usually supposed to cSme from 
the urinary organs. If white, they come from the bladder 
(ulceration, desquamation, erosions) ; if red or fleshy, they come 
from the kidney. If brown or dark coloured, or like the scales 
of fishes, they are a very bad sign, worse than all which we have 
named. They suggest the shedding of mucous linings. Parti- 
cles from the bladder or kidneys may not be of moment ; in 
fact if vesical they are a sign of recovery. Some say that can- 
thandes causes white flakes to appear, which are like the mem- 
brane within eggs ; these dissolve when the specimen is shaken 
and impart a reddish tint to the urine. This would be evidence 
of healing and recovery. 

Another form resembles the scrapings from intestines • 
the particles being less broad and of dense consistence If 
reddish coloured it is called orobeal [or tare-like or grumous] 
sediment ; otherwise it is called furfuraceous. The former 
recalls the appearance of decorticated orobs [ervum ervilial, and 
are reddish ; this indicates the presence of oxidized particles* 
which are derived from {a) the liver, (b) the kidney, or (c) blood. 
When they come from the kidney, the particles are more con- 
tinuous and fleshy, whereas in the other cases they are more 
friable When the colour is decidedly yellowish (one knows 
that) theyare of renal origin ; if dusky red (that) they are of 
hepatic origin. But sometimes particles of hepatic origin may 
resemble those of renal origin. 

Another form, more strictly scaly, consists of small bodies 

l!rL S ° r huUs ° f S rain - Such a se diment denotes (i) 

bladder trouble, or (11) grave colliquative disorder of the system 
as a whole. We diagnose (i) bladder trouble if (1) there is itching 

* The mineral constituents which are attached to the organic substance in 
Sl^^SST"* 17 <**«* (*> Partly oxidized and V ^Toj££t^ 



342 THE CANON OF MEDICINE 

at the root of the penis, and (2) the urine is fetid especially if 
O) pus is passed first. Such a state is more probable if (4) there 
are other evidences of maturation in the urine, (5) if the veins 
over the bladder are healthy, and there is no macula there We 
diagnose (ii) liquefaction of humour if there is fever weakness, 
difficulty of micturition, and the sediment is brownish m colour. 
Another form, in which the deposit is like coarse particles 
of barley flour may mean one of four things : (1) oxidation of 
the sanguineous humour— if there is a tendency to redness ; 
(ii) colliquative changes in the membranes and their components 
—if it be white; (iii) local bladder disease— m a few cases. I he 
difference between this and the others is readily made out from 
what has already been said ; (iv) oxidation of the b ood, especi- 
ally in the spleen.— Here the colour tends to be black. 

" Squamous deposits other than those of vesical or renal 
and ureteral origin, occurring in acute, diseases, have a grave 

significance. , 1 1 

■ 2 Fleshy sediments. These, as you already know are- 
usually of renal origin. They are not so if the flesh is healthy 
and there is no breakdown in the body. If the evidences of 
complete digestion are present in the urine, it shows that the 
blood-vessels are healthy. For the urine can show evidence of 
maturation even if the kidneys are diseased, seeing that this 
process begins " above " the kidneys. 

<? Fatty sediment. This, like the preceding, denotes 
colliquative processes in the body. It is more serious if it resem- 
bles u ^old water " in appearance. There are two chief types— 
either ft is abundant and discrete (this being derived from the: 
renal fat) : or scanty and admixed (this being derived from the 
fat of a more distant place). There is no fever, in the former case. 
A white particle like a pomegranate seed may be seen m 
the urine. This will be derived from the renal fat. . It denotes 
that a sanious ulcer has formed, especially in the urethra, especi- 
ally if the sediment sinks promptly. ("In ardent fevers, it 
forewarns of death." Hippocrates.) . 

. 4 Mucoid sediment. This denotes an unnatural humour, 
which is too plentiful within the body and passes out either by 
the urinary tract, or a critical hip-gout, or joint pains. 
The distinction between them is made by the symptoms— whether 

they abate or not. 

' " A dense humour may become rarefied and tenuous, and a 
laudable sediment results. Therefore in the course or acute 
disease, one must not depend on a laudable sediment appearing 



THE CANON OF- MEDICINE 343 

before the time when, maturation (of the disease) is due, or before 
its signs have appeared. It may denote that there is a very cold 
mtemperament of the kidneys.— ~(A very mucoid and abundant 
sediment appearing at the end of an attack of gout or arthritis, 
is a good sign). 

5. Ichorous sediment.. This differs from a crude sediment 
in being fetid. It is -preceded by the evidences of abscess. Its 
particles easily aggregate and separate again. It may be very 
thoroughly mingled with the water ; it may separate out 
quickly from the water. A crude sediment, however, is both tur- 
bid and thick. It does not readily aggregate, nor separate easily. 
The urine is not fetid. The signs of abscess do not precede. 

6. _ Hair-like sediment. This is produced by the coagulation 
of any internal humour, which has been exposed to the innate 
heat on its way from the kidney to the bladder. ' It is sometimes 
white, sometimes red. It clots in the kidney. The clots may be 
as long as the palm of the hand. 

7-_ A sediment having the appearance of yeast soaked in 
water, is_ evidence of gastric and intestinal weakness and of de- 
praved digestion (often due to milk and cheese having been taken). 

8. Sandy or gritty sediment (" Gravel"). This is always a 
sign of calculus whether in process of formation or actually, 
formed, or in process of solution. If red coloured, it shows it- 
comes from the kidneys ; if white, it shows the origin is in the 
bladder. 

A gritty sediment, where there are large particles like those 
of ground grain, is a bad sign in fevers (Hippocrates). 

9. Cineritial sediment. This- is a sign that serous humour 
or pus has altered in colour through long stagnation and breaking 
up of its particles. It may be that it is due to having undergone 
oxidation. 

10. Hirudiniform. The sediment is of the (appearance and) 
colour of leeches. If well mingled with the urine, this denotes 
hepatic insufficiency. If-less closely intermingled with the urine, 
it denotes a trauma in the urinary passages which breaks their 
continuity. If discrete, it shows that the lesion is in the bladder 
or in the penis. This subject is carefully dealt with in the third 
volume, under the heading of " haematuria." 

The appearance of bodies like red leeches in the urine, 
associated with evidences of disease in the spleen, denotes a 
destructive disease in that organ. (It would seem that strings of 
blood clot are here referred to, in which case nowadays we should 
think of a villous tumour in the bladder. Tr.) 



344 THE CANON OF MEDICINE 

Note, that in diseases of the bladder, there is generally not 
much bleeding because the blood-vessels are few in number, 
are slender, and are deeply situated in its wall. 

II. QUANTITY OF SEDIMENT 

659. According as the sediment is abundant or scanty 
so the degree of the efficient cause is great or small. This has 
been explained under the previous heading. (It is more 
abundant in-gross-living persons than in those who are temperate. 
It is less abundant in active persons than in those leading a 
sedentary life ; hence it is liable to be more abundant in females 
than males, children than adults.) 

III. QUALITY OF SEDIMENT. COLOUR. ODOUR 

660. Black sediment : this is a bad sign, as in the degree 
already shown in 617 ; but it is not so bad if the supernatant fluid 
is not black." (Haly Abbas says it is a fatal sign if it comes on 
after being intensely red.) 

Red sediment. This shows dominance of sanguineous 
humour (sanguineous plethora) ; it occurs in fasting ; and when 
digestion is imperfect. If it continues to be present for a long 
time it denotes inflammation of the liver. 

Yellow : this denotes great heat, because it is produced by 
bilious humour. It may also show an insidious disease. 

Green colour i this has the same significance as black sedi- 
ment. # 

White colour : this is sometimes good, sometimes bad. 
That is, when it is mucoid, ichorous, or foamy ; because this 
shows that the urine is not a completed secretion. 

Odour. The indications from the odour have already 
been given in describing the other characters. 

IV. CONSTITUTION, COHERENCE AND CONSISTENCE OF PARTICLES 

661. Softness and homogeneity of the sediment which is 
otherwise laudable is more healthy than when met with in a 
urine otherwise not laudable. Discreteness of particles points 
to flatulence and impaired digestion. 

v. POSITION 

662„ A laudable sediment may swim like a cloud or nube- 
cula ; may float on the surface ; or be suspended in the middle 
layers (which shows that maturation has proceeded further than 



THE CANON OF MEDICINE 345 

in the first variety.). If it is rugose or fimbriate and tends to 
sink, it is better ; if it sinks to the bottom it is a sign of still 
more advanced maturation. 

When the sediment is not laudable— it is more satisfactory 
when it is light and rises to the upper layers ; or, if in the course 
or an acute fever, it is black ; when the humour is serous or 
atrabilious, it is more satisfactory when it is like a cloud than for 
it to sink to the bottom ; the fact of its being like a cloud shows 
it is tenuous, unless by chance gas is making it rise. 

If the sediment sinks below the surface, but not right to the 
bottom it is more satisfactory. It is heat which makes it rise or 
float ; or it is gas which carries it upwards. 
m If a sediment made of coarse discrete particles should float, 
it shows it is light. A fine sediment, especially if heavy, will 
sink lower. J 

If the sediment remains suspended as a nubecula right 
through an illness from its beginning, it shows that crisis will 
come with suppuration. 

A -r ubecula or suspended sediment may never appear in an 
illness if the person be slender, as we have stated. 

A sediment which is between a cloud and an enaeorema— 
made of particles suspended or floating in the middle layers like 
a spider s web (or opaque like a thin pancake— Rome edition) 
is an ominous sign. (Such particles may appear like the specks 
of oil which one sees in cooled broth ; or like hairs.) But even a 
nubecula may be an anxiety, though it be the beginning of a 
change for the better. It sinks to the middle layers and ul- 
timately to^ the bottom. In that case it is not a bad sign. But 
if a " bad " sediment appears after this, it is certainly ominous. 

VI. TIME OCCUPIED IN SEDIMENTATION 

663. If the sediment settles rapidly, it is a good sign, 
showing that maturation is correct. If it settles slowly, it is not 
good, for it shows deficient or absent maturation, according to 
its amount. . 

VII. FORM 

664. The significance of this has been described in making 
mention of passing blood and fat with the urine. 

7. .Signs relative to the Daily Quantity of Urine ' 

_ 665. Generally speaking, oliguria means weakness of 
vitality. If the amount is less than the fluid consumed, it points 



346 THE CANON OF MEDICINE 

to great loss by diarrhoea or to a tendency to dropsy. Polyuria 
sometimes means colliquation, and the discharge of fluid effete 
matters from the body by the urine. 

To assess these correctly, one must note the state of the 
vitality, as follows : if the urine be of bad colour, it is a bad sign; 
but the more plentiful it is, the more likely is recovery to take 
place. If the quantity excreted fails, the illness will increase, just 
as applies in regard to dark or coarse urine. 

666. Variation of quantity. It is a bad sign if the urine is 
at one time abundant, at another scanty, at another suppressed. 
It shows that there is a hard conflict between the vitality and the 
disease. A plentiful urine in an acute illness, occurring without 
any abatement of symptoms, and associated with copious sweats, 
shows hectic fever and may be followed by convulsions. 

The quantity of night urine (9 p.m. to 7 a.m.) should equal that passed in two 
hours during the day. If greater, it denotes arterial disease (Comne, B M J 1922 
p. 107 1). Vallery-Radot states that the day-urine is normally thrice the night 
urine. 141 

667. A scanty urine, passed involuntarily, drop-by-drop 
in acute diseases, indicates cerebral disease, affecting nerves and 

ixru.scJ.es, 

If a fever subside and there are other signs of recovery, 
one may predict epistaxis. Otherwise delirium will ensue and 

death is likely. 

When a person is in apparent health, if the amount of the 
urine is diminished and it is tenuous in character, and if that 
condition persists, and if there is a sense, of heaviness and pain 
in the loins, this shows that there is a hard inflammatory swelling 

in the kidney. _ . 

668. When the urine is increased in a case of colic, this is 
a good sign,, especially if it be white and easily voided. 

8. Description of Normal Healthy Urine 

669. The following are the characters of healthy urine : 
A medium consistence ; a delicate tint, tending to straw-yellow; 
if there be any sediment it is white, light, homogeneous, and has 
a rounded contour ; the odour should be moderate, neither 
offensive, nor altogether absent. : 

Some say that if a urine of this kind appear suddenly at 
the end of the acme of an illness, health will be restored the 
following day. 



THE CANON OF MEDICINE 347 

9. Variations according to Age 

^670, Infancy. The urine tends to the characters of milk, 
considering the food and their moist temperament. Hence it is 
nearly colourless. 

Childhood. The urine is thicker and coarser than in 
adolescents, and more turbid. This has already been mentioned. 

Adolescence. The urine tends to igneity, and homogeneity. 

Later life. The urine tends to be white and tenuous, but 
it may be coarse (" thick ") because of the effete matters which 
are now being evacuated to a greater extent by way of the urine. 

Decrepit age. The urine is whiter and still more tenuous. 
A similar coarseness to that of the preceding may occur, but this 
is rare. If the urine becomes very thick, it intimates liability 
to develop calculus. 

10. Variations according to Sex 

671.. Women. The urine is always thicker, whiter and 
less pellucid than in males. The reason is fourfold : In women 
there is feebleness of digestion ; abundance of effete matters ; 
width of emunctory channels ; material discharged by way of 
the uterus, which draws similar material down the urinary 
passages also. 

Men. When the urine is shaken, it becomes turbid and 
the turbidity ascends to the surface, though occasionally it 
remains throughout the whole bulk of the urine. When the 
urine in women is shaken, it does not become turbid because 
the particles are barely discrete, and there is usually a. circular 
foam on. top. Even if such urine becomes turbid, it does so 
only to a light extent. 

If male and female urine be mingled, a filamentous network 
forms at once. (Filaments also appear in male urine if passed 
immediately after intercourse.) 

672. Pregnancy. The urine is clear and there is a surface 
cloud. The colour may approach that of chick-pea water, or 
be yellow with a bluish or iridescent tint in it. In either case 
there is a sort of " tinted cotton " in the midst of it. Occasionally 
there are granules present, which rise and fall. If the iridescence 
(" rainbow tint ") be quite distinct, it is a sign that conception is 
beginning. _ When it gives place to redness, it shows that im- 
pregnation is completed, especially if the urine becomes' turbid 
on being shaken. 



34 8 THE CANON OF MEDICINE 

Puerperium. The urine is often dark, as if there were a 
sootiness or shoemaker's black in it. 

ii. The Urine of Animals and its Difference from 

Human Urine 

673. It is" often desirable for a doctor to know_ something 
about the urine of animals, so that when he is tricked by a 
patient, he can quickly and truly discern it, difficult though it be 

to do so. 

Asses. Some say that the. urine is like clarified butter as 

to turbidity and coarseness. 

Beasts of burden. The urine is similar to the preceding, 
but clearer. The upper middle part of the urine is clear, while 
the lower middle part is turbid. 

Sheep. The urine is (nearly) colourless, with a yellowish 
tendency approximating that of man. But it has either no 
" body " and the sediment is fatty, or it is like oil-lees. 

The better the quality of the food, the clearer is the urine. 

She-goats. The urine is like human and sheep urine, but 
it has no " body," or sediment ; and is clearer than sheep urine. 

12. Fluids resembling Urine, and how to Distinguish 

Them 

674. Acetous syrup and all fluids compounded of water 
and honey, water and figs ; fluids coloured with saffron and the 
like — in all these the nearer one holds them to the eye the clearer 
do them seem, and the further they are held from the eye, the 
more opaque do they become. Urine is the opposite. 

The foam on hydromel is yellow. 

The sediment from fig-water or from herbal decoctions 
lodges on the sides of the glass and not in the middle. It has no 
definite contour, and does not move its position. 

So much suffices for the description of the states of the urine. 
The individual varieties are discussed in the volume which deals 
with the special diseases. (Book IV.) 



THE CANON OF MEDICINE 

> 238. Tabular summary of the preceding Section. 



349 



1. First stage of 

Digestion. 
Good. 

Moderately good. 

Absent. 

Excessive. 

2. Maturation stage : 

Normal 

Difficult. 

Quite absent. 

3. Completed. 



Aspect, etc. 



Urine plentiful, 

rather opaque. 
Mod. fetor. 

Watery, .limpid. 

Very thick. 

Opaque first, then 
clear. 

Clear first, then 

opaque. 
Opaque. 
Clear ; denser. 



Digestion of 
Humours. 

1. Immaturity in 

general. 

2. Serous humour. 

3. Vitreous serous 

humour. 

4. Vitelline bilious 

humour. 



Turbid. 

Opaque or dense 
Foam persists. 
Plentiful. 



Dense. 



Oxidation of 
Humours. 

1. Sanguineous. 

2. Serous. 



Gross humours matur- 
ing. 

Cold humours putre- 
fying. 



Fasting State. 



Intemperaments. 
1. Hot. 



2. Cold. 



Limpid. 



Thick, opaque. 
Offensive odour. 



Very acrid. 



3. Dry. 



Dark. Offensive. 



White, turbid, 
limpid. 

No odour. 
Limpid. 



Colour. 



White. 



Pale ; or yellowish 
(bil. hum.). 



White. 



Tends to be dusky. 



Colour appears. 



Deposit.. 



White. 



Foam persists 
yellow. 



Homogeneous. 

Round contour, 

red. 
Gritty,scaly,black, 

green, or livid. 



White, homogene- 
ous, delicate, 
sinks to bottom. 

Discrete particles, 
sinks slowly. 

Rapid, propor- 
tional to com- 
pleteness of 
digestion. 



Mucoid. 



Powdery, 

compact, not 
homogeneous. 



Tends to red. 
Mucoid. 



High. 



White, if heat due 
to dominance of 
bilious humour. 

Red if serous hum- 
our is obstruct- 
ing bile ducts. 

Other colours. 



Coarse particles 
like barley flour. 

Scale-like bodies 
float in it ; 
cineritial. 



Red. 



35° 



THE CANON OF MEDICINE 



Vitality : — 

Deficient, because of cold inteni- 

perament. 
Weak. 
Innate heat too great. 

Innate heat increasing. 
Innate, heat subsiding. 
Innate heat extinguished. 



Functional activity of Organs. 
Liver-inflammation . 

Splenic disease. 
Renal inflammation. 

Venous congestion. 
Stone in bladder. 



Special diseases : 
Obesity. 

Puerperal convulsions. 
Fevers just before crisis. 
Fevers at other times, etc. 

At the crisis. 



Turbid. 

Oliguria. 

Colour deepens to red-yellow. 
Odoriferous. 

Colour deepens to flame yellow. 
The urine clarifies. 

Urine dark or black ; in acute diseases it 
becomes colourless. 



Turbid, red urine ; sediment orobeal or tare- 
like, or dusky red, or hirudiniform. 

Sediment hirudiniform. 

Red urine ; no deposit if grave ; otherwise 
orobeal, or fleshy, and yellowish. 

Limpid urine. 

Dark. 



Urine abundant. 

Urine dark. 

Urine may become thin and transparent. 

Opaque urine : depends on which humour is 

responsible and on outcome of illness. 
Polyuria ; dark, or black. 



Corresponding 


table from 


a modern 


textbook. 


(J. K. Watson, p. 156.) 


Disease. 


Quantity. 


Colour. 


Odour. 


Deposit. 


Additional 
Modern 
Facts. 


Acute Gout 


Diminished 


High 




Urates 
abundant 




Acute Nephritis 


Diminished 
or absent 


Blood- 
stained 




Blood casts 
urates occ. 


Urea diminished 
Albumin 


Chronic Cystitis 


No change 


Turbid 


Offensive 


Mucoid pus 


Alkaline 


Chronic 

Nephritis 


Increased 


Pale 




Scanty 


Albumin varies 
Tube-casts 


Diabetes mell. 


Increased 


Pale 


Sweet 




Urea incr. 
Glucose 
Diacetic acid 


Fevers, general 
and_special 


Diminished 


High 
Turbid 




Urates 


Urea incr. 
Albumin, blood, 
tube-casts 


Gastric Catarrh 


Normal 


High 




Urates 
Oxalates or 
Phosphates 




Heart and Lung 
. Disease 


Diminished 


Dark 




Urates 


Albumin 


Jaundice 


Normal 


Frothy 
Greenish- 
brown 




Varies 


Bile present 



THE CANON OF MEDICINE 351 



§239. Considerations arising out of this section. — For the 
detection of changes in the composition of the urine, the ancients 
were restricted to the evidence afforded by its colour, odour, and what 
may be called its " texture " (though this term applies usually to 
solid substances). The evidence was apt to be fallacious because 
wide differences of composition may produce similar appearances, 
etc., and differences of appearance do not always denote noteworthy 
changes of composition. 

On the other hand, the limitations in the utility of these simple 
observations were balanced by the relatively vague conception of 
the bodily functions. The whole outlook on disease was lacking in 
detail without being basically incorrect. Thus, many diseased states 
were ascribed to defective digestive processes, a fact often overlooked 
to-day in the counter-attraction afforded by the study of diseased 
conditions which are not so ascribable. To say that the whole body 
is concerned in digestion is, broadly speaking, correct, especially if we 
realize that the term digestion covers what we call metabolism. In 
the Canon, digestion is viewed in two aspects : (1) that which' begins 
■in the alimentary canal and ends in the liver : (2) that which is called 
" maturation," which concerns the digestive products in their course 
through the body and ending in the tissues. If such maturation is not 
completed, surplus substances appear, and may undergo sedimenta- 
tion. The phenomena of disease are attributable to this defective 
'maturation. Consequently, the business of diagnosis and prognosis 
comes to be a matter of assessing the efficiency or otherwise of 
maturation. 

The study of the urineis therefore directed to this assessment, -its 
different physical properties being noted, both in health and under 
yanous_ unhealthy conditions. Translucence, opacity, separation out 
into visibility of various substances, the appearance of gaseous matter 
(in foam), and changes in odour — all these are interpreted in the light 
of the two-fold division of digestion above referred to : that cul- 
minating in the liver, and that culminating in the tissues. 

This basis of study is reasonable, and it is not right that they 
should have been superseded as is the case in modern times. We are 
armed with a knowledge of innumerable chemical details about 
the substances met with in metabolism and nutrition in general. 
We have within our reach the very answers, in vastly improved 
detail and accuracy, to the selfsame questions which were para- 
mount to Avicenna. But this technical laboratory knowledge 
tends to be sterile. Urinalysis informs us of the presence of ab- 



352 THE CANON OF MEDICINE 

normal substances, and of the amount both of these and of normal 
urinary constituents. By their means we reach conclusions about 
the functional capacity of various organs, and decide whether 
organic renal disease is present or not. But this is insufficient. 
In the first place, these organs belong really only to. one system— 
the nutritive ; and in the second place, the illness has proceeded 
to another phase^ before the information from the analysis is 

Moreover, the clinician has already taken up his tale before 
the laboratory work can possibly reach completion, so that those 
whom he instructs naturally receive the impression that such work 
is parenthetical, if not purely ritualistic. The clinical aspect of 
the case is discussed on its own merits, as might be done with a 
museum specimen which is possibly unusual, or with some topic 
for a connoisseur. The pathological aspect of the case, again, 
has a different, and separate interest. _ 

It is not enough to combine these different aspects. Functional 
activities, morbid states, and clinical manifestations must centralise 
in the patient, and they do so, not because he happens to exhibit 
them all, but because they are one unity— himself. The organs 
whose capacity has been assessed are the gateways of entrance and 
departure ; the crafts of the body— its real life— proceed in the tissues, 
which are the analogues of streets, houses, shops, plazas and bazaars. 
There are also the gateways of the senses, and these are direct 
routes into the audience-chamber of the presiding sultan himself. 
But he is not a separate being.. He is in every member of the 
community— organs, tissues, sense-organs. Equity reigns through- 
out, and must be considered as much as the invaders of his domain. 
' So if we visualize in a practical form everything that is relevant, 
we must not forget the dynamic aspect of the matter. Changes 
are going on hour by hour, and the laboratory cannot keep pace 
with them. Consequently, we shall in the end make use of the self- 
same data which Avicenna relied on entirely, and we learn from him 
to scrutinize the urine— not merely to find such things as albumen, 
blood or pus and casts— but deliberately to know :(i) Is there any in- 
sufficiency in the digestive processes in the pre-hepatic stages ? 

(2) If not", is there any hepatic insufficiency, and in what direction ? 

(3) If so, or if there is trouble in the tissues at large, arising out of an 
abnormal condition of one or more of the " humours "—which is at 
fault > In what way is it at fault ? Is it entirely morbid or not ? 
What decree as well as kind of defect is there— in modern chemical 
terms ? & (4) What is the degree of vitality of the patient (Avicenna 
included " innate heat " in this) ? is the vitality increasing, or failing, 

or inactive ? recovery from illness, or its duration, or succumbing to 

illness is often primarily a matter of vitality. (5) Other questions. 

Such fundamental questions the modern practitioner (even in 
cities^ can still answer from the simple data used of old, and combine 
themwith the intimate study of the pulse, to realize the nature of the 
processes in the organs and tissues of the sick from day to day, and 
feel himself actually armed with that real insight into the state of the 



THE CANON OF MEDICINE 353 

particular patient which relatives and friends sometimes incorrectly 
assume him to have. 

Changes in the urine were further studied in those days to decide 
on the presence 'or absence of inflammatory states in general on 
febrile conditions in general, and to draw a relationship between 
•these changes and certain symptoms, such as headache, pains in 
various parts of the body, palsies. In such cases, the character of 
the urine reveals the "nature of the pathological changes in the 
humours, out of which the disease has arisen. 




THE ALVINE DISCHARGE 

675. The following are the characters to note : the quan- 
tity ;_ the consistence ; the colour ; the form or shape ; and 
the time occupied in the passage of food through the bowel. 

i . Quantity. If greater than the amount of food taken, 
the reason lies in abundance of humours ; if smaller in amount, 
the reason lies in deficient amount of humours, or in a retention 
of the food in the caecum or colon (in which case, it is the first 
step to obstruction). The reason may also be that the expulsive 
power is insufficient. 

2. Consistence. Moist excrement denotes defective diges- 
tion or obstruction of some form ; weakness of the mesentery, 
so that it does not absorb sufficient water from the food; fluxion 
from the head ; some constituent of the diet which causes the 
dejection _ to be moist. If the faecal matter is both moist and 
viscid, this shows that there is colliquation in the tissues. Fetor 
is then present. It usually denotes an excess of depraved and 
viscous humours ; and the fetor is then very great. It may 
denote the presence of viscous and " hot " constituents in the 
food, with defective digestive power. 

Frothy faecal matter indicates an admixture with flatulent 
vapours, or exposure to great (innate) heat. 

Dry stool results from (a) severe toil ; (£) dispersal of innate 
heat ; (c) polyuria ; (d) igneous heat ; (e) dry aliments ; (/) a 
long delay in the intestines — as will be explained in the appro- 
priate chapter. When the faecal matter is both moist and hard, 
the^ dryness is due to (i) undue delay in the intestines due to 
moisture which cannot escape ; (ii) lack of bile, which serves 
to help on the excrement. 

2A 



354 THE CANON OF MEDICINE 

If there has' been no delay, and there is no evidence of 
moisture in the intestines, it shows that there is a continual 
dispersion of sanious and pungent effete matter from the liver 
into the intestine, until the latter has taken it all up. 

3. Colour. The normal colour is ruddy, owing to the 
presence of a slight fieriness. If this colour is more marked, 
it shows that the bile is plentiful. If less marked it indicates 
defective maturation of the food. 

White stool points to obstruction in the biliary passages, 
and goes with jaundice. If there is also offensive sanious material 
present it shows that an inflammatory mass has ruptured. 

A healthy person who does not take exercise often passes a 
morbid sanious matter which acts as a purgative and produces a 
satisfactory evacuation. For by this means laxity of the tissues 
is avoided (tarahhul, the swelling of the flesh, in horses), which 
lack of exercise is liable to produce, as we have already explained 
when speaking of the urine. 

Unduly red colour of stool at the acme of a disease often 
denotes maturation ; it often points to a depraved constitution. 

The significations of dark-coloured or black stool are similar 
to those of dark or black urine. It means (a) marked oxidation ; 
(b) maturation of a disease due to atrabilious humour ; (c) an 
aliment which colours it ; (d) a medicament which procures the 
discharge of the atrabilious humour. The first is unfavourable ; 
the second is merely a staining from admixture with black bile ; 
this cannot be clearly discerned from colour alone, but only by 
its acridity, bitterness and the churning out of earthy matter 
from it. Moreover, among its peculiar properties is this, — 
that it glitters (is self-luminous). The fact of black bile leaving 
the body, whether it be by the stool or by the vomit, is a bad sign. 

Finally, the discharge of pure atrabilious humour per anum 
is usually a sign of impending death. But the exit of black 
chyme is beneficial because it shows that the tissues are active in 
oxidation, and their moisture is used up. 

Blackness of stool also denotes admixture with blood, in cases of disease of 
the liver, intestinal ulcer, or rupture of vessels (Aegineta). 

Green stool. This denotes extinction of the innate heat. 
The colour is due to the verdigris-green type of bile. 

Dark-coloured or " livid " stool. This also denotes extinction 
of the innate heat ; coldness ; considerable mortification in 
the interior organs. It is a bad sign. 

Parti-coloured stool. This is a bad sign. Reference to this 
is made in Book IV. 



THE CANON OF MEDICINE 355 

_ Fatty stool. This is met with when the fat of the body is 
being dissolved out. 

_ Glutinous stool. In this case'other tissues as well as the fatty 
tissue are being liquefied. It is a very grave sign. 

Purulent stool. The pus comes from the liver, or stomach, 
or bowel. ' 

Intensely yellow stool ; when occurring at the beginning of 
a disease it is due to bilious humour. If at the acme, it is useful 
m that it purges the body (of undesirable substances). 

Unusual colours in the stool, and the various colours which 
have a bad significance are spoken of in the special volume. 

4-. Form or shape. If the faeces are bulky like those of a 
cow it is because of flatulence, or gaseousness. 

5 ' u ^ ME OCCUPIED IN PASSAGE THROUGH THE BOWEL 

When the faeces are passed out too rapidly it is a bad sign •" it 
shows that there is an excess of bile in the gall-bladder, and also 
a weakness of the retentive power. 

A delay in the passages of faecal matter through the body 
denotes a feeble digestion, coldness of the intestines, abundant 
moisture ; taking too much sleep ; flatulence. 

The Characters of Normal Stool 

676. The stool should be (i) coherent ; (2) homogeneous 
throughout the water and the solids being intimately admixed ; 
(3J soft and honeylike m consistence ; (4) easily evacuated ; 

u c C t° r tendm S to y ellow ( if ^e colour should resemble 
that of the food it would mean indigestion) ; (6) of not very 
offensive odour, yet not odourless ; (7) of a quality which is 
neither sharp nor biting ; (8) it should emerge inaudibly, 
neither with gurgling, nor flatus, nor creaking, nor foamy ; 
(9) passed at the time customary to the healthy person ; (10) in 
bulk nearly equal to that of the food consumed. 

Note that neither homogeneity nor softness is necessarily 
a laudable character m faeces. These characters may be the result 
of violent maturation throughout the body, or of oxidation or 
co liquation. In such cases, these features would be unfavour- 
able signs. 

Note, too, that a consistence which is tending to tenuity 
is not favourable unless there is no rumbling or discharge of 
flatus at stool ; it should not then emerge bit by bit. But one 
must also be sure it is not being discharged in that form owing 
to the admixture of some irritant which prevents cohesion 



35 6 



THE CANON OF MEDICINE 



677 Many authors proceed from the discussion of urine 
and faeces to other excretions, including the sweat. I consider 
it more appropriate to deal with these under, their appropriate 
headings in the volume on special diseases. 



THE EXPECTORATION 
(From Aegineta ; Haly Abbas) 
§ 24 o. The expectoration denotes some affection in the organs of 
respiration. . 



Consistence. 



Colour. 



Quality. 



Thin and scanty. 

Moderate ; homogen- 
eous, white, 
unctuous. 

Thick. 
Indefinite. 



Cause. 



Attenuated humour. 
Attenuated humour. 



Density of humour. 



Black or dark. 
Yellow, golden, 

frothy, thin. 
Intense yellow, 

golden, frothy. 
Green. 

Verdigris green. 

White. 

Red. , 



Odour. 



Mode of 
expectoration. 



Intense heat. 
Deficient maturation 



Presence of green 
bile. 

Serous humour. 
Sanguineous humour 



Disease. 



Fetid. 



Easy. 
Difficult. 



Not fully developed. 

Acme of a disease; 
maturation of mor- 
bid substances is 
complete. 

Is declining. 

Failure of maturation. 

Outlook grave. 
Outlook not entirely 
bad. 

Bad significance. 
Fatal sign. 



Putrefaction. 



Lung ; air-passages. 



Good sign. 
Bad sign. 



Any colour other than that of blood is a sign of a bad intemperament produced 
by pathological heat. Admixture with colours is intermittent. 



ssmmmmmms 

— many ounces a day in some cases. 

The Sweat . . 

" -P sterns iudee much by the state of the perspiration, especially m horse- 

v. 488.) 



Menstrual Fluid 
This may be mentioned as being one of the excretions, 
usually only noted in relation to lochia! discharge. 



Its characters are 



Part III 
THE PRESERVATION OF HEALTH 



Preface 

I. On Nutrition 



CONTENTS 

PAGE 
" 358 
363 



II. The Regimen appropriate for the various Periods 
of Life - 



381 



III. The Regimen for the Aged - 

IV. The Regimen appropriate for Various Intemperaments 
V. The Regimen appropriate for Changes in the Climate 

and Seasons ----___ 

VI. The Regimen appropriate for Travellers, Seafarers, 

and those living in Hot and Cold Countries - 446 



432 
437 

443 



357 




PREFACE 

On the Causes of Health and Disease ; the Necessity of 

Death. 

678, In the first part of this book it was stated that 
Medicine comprises two parts, one theoretical, and one practical, 
though both are really simply speculative science. That which 
is specially named " theory " relates to the formation of opinions 
and .the showing of the evidence upon which they are based, 
without reference to the mode of acting upon them. Thus this 
part deals with the temperaments, the humours, the faculties ; 
and with the forms, the symptoms, and the causes of disease. 
That which is specially named " practical " relates to the mode of 
acting upon this knowledge, and the prescription of a regimen. 
For instance, it is that part of Medicine which helps us to 
understand how the health of the body is to be maintained in this 
or that state, and by what means we can heal the diseases with 
which the body is afflicted. " Practical " does not refer to the 
performance of surgical operations. It is the art which teaches 
us in what way to procure healing — the " healing " art. 

Having expounded in the first and second parts of this work 
the various matters pertaining to this theoretical part of Medicine, 
we now proceed to the study of the two subjects pertaining to the 
practical part — dealing with them in a general manner. 

The two parts which belong to the practical side of Medicine 
are (i) The science of regulating the healthy body, so as to 
maintain it in health. The science of hygiene. (2) The science 
of ruling the sick body so as to enable it to return to a state of 
health. The science of healing. 

In this part then, the third, we write down fully how the 
health" is to be maintained. 



358 



THE CANON OF MEDICINE 359 

679. The human being takes its origin from two things — : 
(1) the male sperm, which plays the part of " factor " ; (2) the' 
female sperm [menstrual 'blood], which provides the matter. 

Each of these is fluid and moist, but there is more wateriness 
and terrene substance in the female blood and female sperm, 
whereas air and igneity are predominant in the male sperm. It is 
essential that at the outset of the congelation of the two com- 
ponents there should be moisture, even though earth and fire are 
found in the product. The earth provides the firmness and 
rigidity ; the fire provides the maturative power. These give 
the coagulum (" He created man from a clot " — Q. 96, 2) a 
certain hardness or firmness. But this hardness is not as great 
in degree as that possessed by a stone or metal [or glass]. For 
these are either not soluble at all or only soluble to a degree 
imperceptible to our senses, however long one exposes them to' 
solvents. Were the hardness comparable to this, the product 
of conception would never suffer injury however long or however 
persistently a solvent were applied. But that is not so. The 
fact is contrary. 

680. Our bodies are exposed to injury from two directions 
— one exterior and one interior. The interior source of injury 
is the dissipation of the moisture from which we are created, and 
this dissipation proceeds in an orderly manner. The second 
source is the putrefactive breakdown and metamorphosis of the 
humour, into a form such that the fermentative phenomena of 
life are no longer able to proceed. 

The second source of injury differs from the first in that 
dryness is here introduced in virtue of depravity of humour ; 
and this dryness continues neutralizing the moisture of the body 
until the " form " ceases to have a capacity for life. 

Finally, the putrefactive breakdown disperses the vitality, 
because it first destroys the moisture and then disperses it, and 
simply dry ash is left behind. 

681. Hence we see that these two sources of destruction 
[of the living- product of conception] are different from those 
arising from other causes — such as, freezing cold, torrid heat, 
grave forms of loss of continuity, various maladies. But it is in 
regard to the first two-named sources of destruction that we find 
the more important factors relative to the question of the pre- 
servation of health. 

Each of them takes origin from extrinsic and intrinsic 
agents. The extrinsic agents are, e.g., the atmosphere, which is 
a solvent and putrefacient. The intrinsic agents are, e.g., the 



360 THE CANON OF MEDICINE 

innate heat, which: is the agent within us through which moisture 
is dispersed : the extraneous heat generated within us from the 
aliments, and through other 'agents which cause putrefactive 
changes in the [native] moistures. 

All these agents mutually aid one another in rendering the 
body dry. And yet it is true that our perfection and soundness 
and the power to perform our various actions depend on a due 
degree of dryness of the body. But the degree of dryness 
becomes relatively greater and greater until we die. Hence 
this dryness is inevitable. 

682. If we were at the outset essentially composed of 
moisture, heat would have to overcome it or else the heat would 
be choked by it. Therefore the heat continues to exert its own 
effect, — that is, it produces more and more desiccation. But 
whatever degree of dryness there might be at the outset (of life), 
it reaches equilibrium, and remains so until the limit of equili- 
brium in regard to dryness is reached. The heat remaining 
constant, the dryness is now [relatively] greater than before ; 
for the " matter " is less, and hence holds more. Hence it is not 
difficult to understand that the dryness passes on beyond the 
stage of equilibrium, and goes on steadily increasing until the 
whole of the moisture of the body' is consumed. Therefore (we 
may say) that the innate heat is the cause of its own extinction, for 
it is itself the reason for itax>wn " matter " being consumed. We 
may compare it to the flame of a lamp ; the light goes out when 
all the " matter " has been used up. 

As the dryness increases, the innate heat diminishes. The 
loss continues unceasingly till death, and the moisture which is 
lost is not restored. The loss goes on more and more. 

683. The dryness (of the body) is increased in two ways : 
by lessening of the power of receiving " matter " ; by lessening 
of the native moisture resulting from dispersal of the (innate) 
heat. The heat becomes more feeble because dryness pre- 
dominates in the substance of the members, and because the 
innate moisture becomes relatively less. The innate moisture 
is to the innate heat as the oil of a lamp is to the flame. For there 
are two forms of moisture in the flame : water, which holds its 
own, and oil, which is used up. So, in a corresponding manner, 
the innate heat holds its own in respect of the innate moisture, 
but is used up pari passu with increase of extraneous heat, due, 
e.g., to defective digestion, which is comparable with the aqueous 
moisture of the flame. As the dryness increases, the innate heat 
lessens, and the result is natural death. 



THE CANON OF MEDICINE 361 

684. For the reason why the (human) body does not live 
any longer than it does lies in the fact that the initial innate 
moisture holds out against being dispersed both by the alien 
heat and by the heat in the body itself (both that which is innate 
and that derived from bodily movement). And this resistance 
is maintained as long as the one is weaker than the other, and as 
long as something is provided to replace that which has been thus 
dispersed — to wit, from the aliment. Furthermore, as we have 
already stated, the power or faculty which operates upon the 
aliment in order to render it useful in this way only does so up to 
the end of life. 

685. Therefore we may say that the art of maintaining the 
health is not the art of averting death, or of averting extraneous 
injuries from the body ; or of securing the utmost longevity 
possible to the human being. It is concerned with two other 
things — (a) the prevention of putrefactive breakdown ; (b) the 
safeguarding of innate moisture from too rapid dissipation, and 
maintaining it at such a degree of strength that the original 
type of constitution peculiar to the person shall not change even 
up to the last moment of life. 

• _ This is secured by a suitable regimen, namely {a) one which 
will ensure the replacement of the innate heat and moisture which 
are dispersed from the body as exactly as possible ; and (b) a 
regimen which will prevent any agents which would lead to a 
rapid dessication from gaining the upper hand — excluding agents 
which produce a normal desiccation ; (c) one which safeguards 
the body from the development of putrefactive processes within 
it and from the influence of alien heat (whether extraneous or 
intrinsic). 

_ For all bodies have not the same degree of innate moisture 
and innate heat. There is a great diversity in regard to them. 

_ 686. ^ Moreover, every person has his own term of life, 
during which the desiccation' inevitable to his temperament 
(constitution) and the degree of innate heat, and of innate 
moisture can be withstood. 

687. _ Nevertheless, factors may arise which assist desicca- 
tion, or are injurious in some other way. For which reason, many 
assert that the former are natural causes of death, whereas the 
latter are accidental. And under this view, the art of maintaining 
health consists in guiding the body to its natural span of life by 
paying attention to whatever things conduce thereto. There are 
two faculties to be fostered by the doctor in striving for this 
object : (1) the nutritive faculty, whereby that is replaced which 



3 62 THE CANON OF MEDICINE 

is constantly being lost to the body — namely earthiness and 
aquosity ; (2) the sensitiye faculty (animal faculty) — that is, the 
pulsatile faculty which is concerned with the replacement of that 
which is lost to the body by the breath — namely " air " and 
igneity. And since aliments are only potentially like the thing 
nourished, an alterative faculty had to be created so that they 
could be changed actually into the likeness of the thing nourished. 
In this way the aliment becomes effective. 

The instruments and channels necessary for this had to be 
created also — namely the means by which material is attracted, 
expelled, retained, and digested (sequence by sequence, turn by 

turn). 

688. Therefore we may say that the essential considera- 
tions in the art of preserving the health consist in maintaining 
equilibrium between all these various concomitant factors. But 
there are seven matters concerning which special care must be 
expended to ensure just proportion : 

(1) Equilibrium of temperament. 

(2) Selection of the articles of food and drink. 

(3) Evacuation of effete matters. 

(4) Safeguarding the composite. 

(5) Maintaining the purity of the air respired. 

(6) Guarding against extraneous contingencies. 

(7) Moderation in regard to the movements of the body 
and the motions of the mind, with which may be included sleep 
and wakefulness. 

689. From all these considerations you will now perceive 
that there is no single fixed limit to which equilibrium, or health is 
to be assigned. None of the temperaments enters into it. 
Health and equilibrium vary (in range) from time to time. That 
is to say, it is a state comprised within two limits. 

We therefore begin by discussing first the regimen appro- 
priate to the period of infancy, in which the temperament is 
continuously at one extreme of equilibrium. 




THESIS I 

• . ON NUTRITION 

i. The Regimen in Infancy — the Period from the Moment 
of Birth to the Commencement of Weaning. 



PECIAL chapters discuss the regimen dur- 
ing pregnancy and the period when par- 
turition approaches. 

690 Treatment of the Cord. Many- 
wise physicians state that when an infant of 
equable constitution is born, the umbilical 
cord should be severed four fingers' breadth 
from the umbilicus after it has been well but 
gently tied with a clean woollen ligature, so as to inflict no pain 
and that an oiled cloth should be placed upon it. To help the 
separation of the cord, apply equal parts of the following • 
turmeric, dragon's blood, Persian gum, caraway, sweet scented 
moss, myrrh. These are ground together and applied. 

691. Treatment of the skin. Then one should hasten to 
harden the surface of the skin by the use of slightly salted water 
until the cord has desiccated. The best agents to employ for this 
purpose are shadanaj (a stone, shaped like a lentil or bloodstone), 
bitter costus, sumach, fenugreek, and origanum. But the nose 
and mouth must not be exposed to such agents. 

_ The reason for hardening the body in this way is that every- 
thing hot, cold, or rough is injurious to the sensitive infant's skin, 
and so it needs to be hardened against all things of that kind which 
will come m contact with it. Hence, if the process of salting 
has to be repeated, so do. 

Such treatment is the more indicated if there are sordities 
or there is much humidity. 

After this, the body should be laved in tepid water, the 
nostrils thoroughly cleansed with the fingers, whose nails are cut 
short, and a little oil should be instilled into the eyes. The anal 

363 



364 THE CANON OF MEDICINE 

orifice should be caused to move by manipulation of its vicinity 
by means of the little finger, so that it may open. Care should 
be taken that nothing cold conies in contact with it.^ 

After the cord has separated — which should be in three or 
four days— the stump should be treated with a measure of bone- 
ash or powdered lead oxide in wine. 

692. Binding the Infant. In doing this the limbs must be 
handled very gently. Every part should be moulded according 
to its appropriate form — making wide that which should be wide, 
slender that which should be slender, doing all as gently as 
possible between the tips of the fingers. This should be done 
many times. 

The eyes must be carefully wiped with a silken band. 

The bladder-region should be pressed to help the exit of the 
urine. After this, stretch out the hands towards the knees. 
Bind the head, fitting as it were a cap to the head. 

693. Sleeping-quarters. The infant must be placed in an 
airy room, with not too cool air. The room should also be shady, 
or even slightly gloomy so that the eyes are not likely to receive 
direct light. While sleeping the head should be at a higher level 
than the rest of the body, and someone should watch lest any part 
of the body (neck, limbs, back) should get into a twisted position. 

694. Bathing the Infant. In summer time it should be 
bathed with suave tepid water. In winter the water should be on 
the warm side. 

The best time to wash the infant is after a long sleep, but it 
may be desirable to wash it twice or three times in the day. 

In winter, the infant should not be washed unless its body 
becomes ruddy and warm thereby. After taking it from the bath, 
take care none of the water gets into its ears. 

695 „ The way to hold the infant while washing it : take it 
by the right hand, and hold it so that the left arm is over its chest 
and not over its belly. After the laving, the palms and soles 
should be gently raised (up and down). It should be gently 
wiped dry with soft cloths. Then turn it down on to its belly, 
then back on its back, rubbing gently all the while, pressing and 
moulding [and singing gently to it, — Ch.M.], then back on its 
belly to apply the binder. Afterwards instil sweet oil into its 
nostrils, and bathe the eyes and lids. 

2. The Regimen during Lactation and Weaning. 

698, The following is the mode in which the feeding of 
the infant is to be arranged. Whenever possible, the mother's 



THE CANON OF MEDICINE 3 6$ 

milk should be given and by suckling. For that is the aliment of 
all others most like in substance to the nutrient material which the 
infant received while in the womb — the menstrual nutrients of 
the mother. It is these which are changed into milk after 
parturition, and such milk is better adapted for the infant. 

Macrobius (Saturn, v. n) gives the following reasons why the healthy mother 
should suckle her child. " Just as the strength and nature of the semen goes to 
fashion the likeness of the bodv and mind, so the natural dispositions and properties 
are conveyed by the milk. And it is not only in man that this is noticed It 
occurs m cattle also. For it is easily shown that when young goats are brought up 
on sheep's milk, their hairs become softer, and when lambs are brought up on goat's 
milk the wool becomes harder." 

Experience shows that merely to place the mother's nipple 
into the infant's mouth is a great help towards removing whatever 
is hurtful to the infant. 

697. " It should suffice for the infant to suck the breast 
twice or thrice in the day at first, and it should not be allowed 
to take too much. It is best to wait till the [disturbance in the] 
temperament of the mother has subsided somewhat before the 
infant is given the breast. It may be give a little honey first, and 
the breast later. 

The milk which the boy sucks should be drained away two 
or three times in the morning, before presenting the nipple, 
especially if there be any spots in the milk. Sourish or otherwise 
defective milk should not be given while the nurse is fasting. 

698. Besides this there are also two other things to be done 
to help to strengthen the constitution : gentle (rocking) move- 
ments ; humming music or some old song, or prattling to the 
infant, as is customary while placing the babe into it's cradle. 
How much these two practices are to be employed may be judged 
[individually] ; the movement is for the benefit of the body, and 
the music is for the benefit of the mind. 

§ 240a. — Some idea of the cradle-songs actually used in the days 
of Avicenna may be formed from the instances recorded by Fox- 
Strangeways in his work on the Music of Hindostan (pp. 62-68). 
The words of Rama's lullaby may be quoted : "In Ayodhya, the 
land of kings, It was Vishnu's self That was born on the lap of 
Kaushalya. Little babe, sleep upon my knee ! — For the cradle is 
wrought of gold, And a Child therein, Of the whole world the Lord 
and Master, sleeps. Little babe, sleep, sleep, upon my knee !— - 
In the hand-hold of Kaushalya Is the cradle-cord, And the cord is 
the thread of Bodhana (= Knowledge). Little babe, sleep upon 
my knee.- — And the Devis (= angelic beings) are strewing flowers 
From the highest heaven, And with each flower a' blessing on the 
Child. Little babe, sleep upon my knee ! " 



3 66 



THE CANON OF MEDICINE 



Another illustration may be quoted to show the beautiful spirit 

in these lullabies. In singing such words over her babe, the mother 

must surely create an atmosphere around it which is for the benefit 

of its mind : 

" Baby mine, light of my eyes, 
Here in. thy cradle bright with flowers 
Through sunny hours I bring thee sleep, 
I rock thee and sing thee to sleep 
Oh the wings of my melodies . . . 
Srinangam island rises fair 
Where the divided Kaveris meet 
I lay thee down there at His feet, 
At Srlranga raja's feet 
Full sure of His tender care . . . 
The golden nails no longer move 
On which my baby's cradle swung ; 
The' song is sung ; my ship is borne 
Safe home, my ship is borne 
Safe on the ocean of love. . . ." 



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699. Inability to nurse the Child. If there be anything to 
prevent the mother from giving milk to the babe — for instance, 
owing to her weakness or to the defective quality of her milk, or 
because it runs too quickly, a wet-nurse should be selected 
according to the following rules : (i) age ; (2) form or phy- 
sique ; ( 3) personal character or habits ; (4) the shape of the 
nipples ; (5) the quality of the milk ; (6) the interval of time 
which has elapsed since her parturition ; (7) characters of her 

own child. ..... 

Having found a wet-nurse in whom the requisite conditions 
are fulfilled, she must be provided with nourishing foods such as 
are given in 708, 

700. The characters of a good wet-nurse. (1) The age 
should be between 25 and 35, because during this period there is 
youth and health and perfection. (2) Form and physique. The 
colour should be good, the neck strong, the chest strong and 
broad, the flesh muscular and firm,— neither very fat nor very 
spare, the proportion of the fat in the flesh being moderate. 
(3) Personal character and habits. These should be good and 
praiseworthy. She should be only slowly aroused by the bad 
passions of the mind, such as anger, gloom, fear, etc. For all 
these injure the constitution and may change the milk or pass into 



THE CANON OF MEDICINE 3 6y 

it, or even prevent -its secretion. It is for this reason that some 
people reject a nurse who is stupid. Besides this, if the character 
be not good, she will riot trouble herself over the infant or caress 
it enough. (4) Shape of nipples. They must be firm in con- 
sistence and large, but not too large. [On the one hand large 
nipples hurt the infant's gums and impede deglutition, and on the 
other they will hold more milk than the infant can take, and some 
is then left behind to undergo decomposition, therefore being 
injurious at the next feed. If the nipples are too small, the infant 
cannot take hold of them, and there will not be sufficient milk : 
Aetms.] Therefore the consistence should be between hardness 
and softness. (5) Quality of milk. The consistence must be 
between coarse and fine ; the colour white (not dusky, greenish, 
yellowish or ruddy) ; the odour good, without acridity or 
pungency -; the taste sweetish (without any bitterness, saltinesss, 
or acridity). The quantity should be of a certain amount. It must 
be homogeneous. It must not be thin, watery, nor very thick or 
cheesy ; nor must there be any discrete particles in it. There 
should not be much foam. 

701 . Tests. The consistence may be tested by allowing 
the milk to run over the finger-nail. If it flows easily, it is thin ; 
if it does not flow over the inclined nail, it is thick. Again' 
pkce some in a glass vessel, and drop a little myrrh into it, and 
stir the two together. The aquosity and the degree of caseity 
are then evident. The milk is laudable and attempered if 
the watery part and cheesy part are equal. 

Should there be some special need to prepare such a milk, 
we should prepare it partly from the mother, and partly from 
the wet-nurse. From the mother because it is better not to 
give thick milk of unhealthy odour until it has been allowed to 
stand exposed to the air for a while ; and because it is best 
not to give very warm milk to the fasting infant. 

7Q2, Diet. If her milk is thick, the wet-nurse should 
take oxymel ; and a decoction of attenuants such as wild r.^r-, 
joram, hyssop, thyme, savory, origanum montanum, and the 
like should also be included in the menu. A little radish may 
be added [old pickle in vinegar and honey : Aeg.]. Vomiting 
should be induced with hot oxymel to get rid of the phlegm, 
(Suitable) work before meals will help to thin the milk. [Fre- 
quent baths : Aetius.] 

If the wet-nurse be of hot intemperament she should take 
acetous syrup, and a light wine should be taken either at the 
same time or separately. 



368 THE CANON OF MEDICINE 

703. If her milk is thin, one should instruct the nurse to 
rest, and'avoid exercise or work, and she should be given foods 
which thicken the blood. If there is no contra-indication, one 
might allow her sweet wine. [The following are also recom- 
mended : strong soups or broths (Aeg.), a gruel prepared with 
fennel ;. green dill boiled in a ptisan with fine bread, pork-flesh, 
flesh of kids, or of tender birds : Aetius.] Allow plenty of sleep. 

704. If the milk is scanty, one should ascertain the cause : 
e.g. is it" an abnormal temperament affecting the whole body, 
or" the breast itself? To determine which it is one employs 
the indications given in preceding chapters. If palpation of 
the breasts shows them to be unduly hot, the diet should consist 
of such things as barley water, spinach, and the like. If there 
are signs of coldness of temperament in the breasts, and of 
obstructions, or inadequate attractive power, the diet should 
include attenuated aliments tending to a warm nature ; and 
cupping instruments should be applied beneath the breasts, 
taking care not to press much on the breast. Carrot seed is 
also beneficial, and the carrot itself is also very good for such 
a condition. . 

Should the cause be that the nurse has been previously 
insufficiently fed, she should be given a broth made with barley, 
bran and legumes, and such as the following should be intro- 
duced : fennel roots, and seeds, and dill, and nigella. Others 
say that the udders of sheep and goats should be eaten with 
the milk therein contained, as being helpful in virtue of that 
which is of like nature or property in such foods. Others have 
recommended the administration of an " ounce " of tree-worms 
or dried earth-worms in barley water for several days, saying 
they have found it excellent for the purpose. So also the 
expressed juice of the heads of salted fish, taken in dill water. 

705. List of Galactogogues. (i) One ounce of butter from 
cow's milk placed into a vessel of good wine ; taken as a drink. 
(2) sesame ground up in a fine mill and mixed with wine ; taken 
as a drink. (3) An emplastrum or liniment applied to the breasts, 
prepared with the faex of balsam of nard and asses' milk and oil. 
(4) Take one ounce of the interior parts of bnnjal (egg-plant;, 
this being dissolved in wine, by stirring ; it is taken as a drink, 
(c) The following is a powerful medicament : dill seed, three 
ounces ; seed of blue melilot* (or, lot tree),t of leek, one ounce 

* Melilot : a sort of clover./ The blue melilot or ' curd herb * gives the odour 
and flavour to Schabzieger cheese, the dried flowers being used 

t The lot tree : pyrus aria, or white beam-tree (apple tribe) (Lmdley and 
Moore) . 1 3 - 



THE CANON OF MEDICINE 369 

of each ; clover seed and fennel seed, two ounces of each ; mix 
the whole into a drink with fennel juice, honey and butter. 
[(6) (Aegineta) : broom leaves taken in dark-coloured wine or 
in a ptisan ; sweet gith (melanthium), and the root and seed of 
carrots soaked in warm water. Aegineta warns that such reme- 
dies are weakening to the body).] (7) Massaging the breasts 
frequently with bland hands renders the secretion of milk 
plentiful. 

706. Anti-galactogogues. If the milk is injuriously abun- 
dant, or has accumulated because it is unable to escape owing 
to the presence of some form of obstruction, or because the milk 
is too thick, one may reduce the quantity secreted (1) by reducing 
the amount of food ; (2) by employing those articles of diet 
which contain but little nourishment ; (3) by applying a (dis- 
cutient) plaster over the chest and breasts, composed of caraway 
in vinegar or white clay in vinegar, or of lentils boiled in vinegar ; 
this is followed up by a draught of salted water ; (4) by eatine 
mint. J & 

If the milk has an unpleasant odour, the remedy is to give 
as a drink a fragrant wine ; and as food, foods of pleasant odour. 

707. (6) Rules regarding the period of time which has 
elapsed since the wet-nurse was herself confined. — The birth 
should have been recent, namely i-| months at least (two months, 
if the child was a male) ; the birth should have occurred at the 
proper date and not premature ; nor should there be a historv 
of habitual premature births. 

708. Regimen of wet-nurse. 

Diet : the aliments should consist of food giving good 
chyme. For example, foods such as wheat, frumenty, lamb, kid 
of goats, which are not putrescent or have hard flesh. Lettuce, 
almonds, filbert-nuts. Mint. Potherbs which are deleterious: 
herb-rocket, mustard, mountain balm— for they cause the blood 
to undergo decomposition. [Aegineta also advises against 
desiccative, salt, acrid, acid, sour, bitter and heating articles of 
food ; foods having an offensive smell ; very fragrant things ; 
condiments ; alcohol.] 

Exercise. This should be moderate. [Aetius says : woik 
with the hands and shoulders, milling, weaving, carrying the 
child about in the arms. ' ' 

Personal : cleanliness of person (Aetius).] The wet-nurse 
should not allow coition, for this disturbs the menstrual blood 
and diminishes the quantity of milk and alters its composition, 
as shown by change of odour. Moreover she might become 

2B 



37 o THE CANON OF MEDICINE 

pregnant, in which case there would be a dual unpropitious 
influence — to the wet-nurse herself in that whatever is attenuated 
in the blood enters into the nutriment of the embryo, and to 
the embryo in that it loses as much from the mother's aliment as 
passes on to form milk. 

709. During the whole period of lactation, especially 
the first lactation, it is advisable to have some of the milk drawn 
off to encourage and facilitate its flow ; this is also aided by 
massage, otherwise the delicate organs of suction will be injured 
and weakened. It is a help to anoint with a little honey each 
time before the infant is nursed ; and a little wine may also be 
added. It should not be allowed to take much milk at one time. 
It is better to feed little and often, at small intervals. For it 
may happen that after becoming satiated with the whole of the 
contents of the breast the infant suffers from distension, and very 
much flatulence, and the urine becomes white [too watery, Aeg.] 
In such a case, the best thing is to stop the nursing, allowing the 
infant to go hungry for some time, and it should be meanwhile 
put to sleep till digestion has had time to be completed. [It is 
unduly sleepy if over-fed.] 

At first, the infant is allowed the breast three times only in 
the day. Should it be necessary to feed it on the first day, it . 
would be better for someone else than the infant's mother to do 
so, as we have explained. 

Should the wet-nurse develop an intemperament or a 
painful malady, or have diarrhoea, or be constipated, someone 
else should give milk until she is better. The same applies if 
it be necessary to administer to her some medicine which has a 
decided potency or quality. 

The infant is laid to sleep after feeding, but its cradle must 
not be rocked vigorously as otherwise one would churn the milk 
in its stomach. The rocking must be quite gentle. 

It is good for the infant to cry a little before the feed. 

710* Duration of lactation. Normally this is two years. 
When something additional to milk is required, such addition 
should be made step by step. Weaning must not be abrupt. 

"He committed the child to the nurse, and he drank milk two 
years, after which they weaned him, and he grew up, and throve, 
and walked upon the floor." (Night 250). 

After the first two teeth have appeared, a progressively 
stronger aliment is to be considered. Hard things, however, 
must not be allowed. At first, bread is given which the nurse 



THE CANON OF MEDICINE 371 

has masticated. Afterwards, bread softened with honey water, 
or dilute wine or with milk. This is followed by a little water,' 
or even a little wine in the water. It must not be allowed to 
take food to repletion. Should indigestion or flatulence occur, 
and should the urine become white, all food is stopped for a 
while, at least until it has been anointed in the bath. 

711. Weaning.- In weaning the infant from milk, the 
aliment must consist of articles which can be sucked up ; and 
the replacement of milk by " acorns " of bread and sugar should 
be gradual. Soft meats may be given. If the infant per- 
sistently seek for the breast, crying for it, the best thing is to 
prepare a paste to apply to the breast, made of four ounces of 
myrrh and smoothly ground pennyroyal. 

712. Regimen up to Dentition. To sum up, we may say 
that the regimen of the infant is to be humectant, corresponding 
to its temperament at this period, for this is necessary both for 
nutrition and growth. The infant is also to be exercised gently 
correspondingly to the needs of nature, and especially during the 
later period of infancy. 

[The word " exercise " includes lulling with music and singing lullabies • 
exercises are to be followed by gentle rubbing ; and after that comes the bath' 
which must not be cold. (Aegineta.)] 

When the child begins to creep about, it must not be 
allowed to make strenuous efforts, or be encouraged to walk or 
sit erect before the natural desire to do so appears ; otherwise 
there may be injury done to its legs and back. When it first 
sits up or creeps over the ground, it is best to place it upon a 
smooth skin, to prevent injury by roughness in the floor. Bits 
of stick or any objects able to pierce or cut the skin must be kept 
out of its way. Care must be taken that it does not fall off some 
elevated place. 

713. Hygiene of Dentition. When the canine teeth are about 
to appear, the infant must not be allowed to chew at anything 
hard lest the material from which these teeth need to be made 
should become dissolved by the processes of mastication. The 
gums should be rubbed with hare's brain and cock's fat, as this 
will _ help ^ their eruption. After the appearance of the teeth, 
the infant's head and neck should be rubbed with oil which has 
been shaken up with hot water [to cleanse it], and a little of the 
same oil may be instilled into the ears. 

As soon as the infant is able to bite with its teeth, it will 
show this_ by trying to bite its own finger. It should then be 
given a stick of not too dry liquorice root or inspissated Spanish 



37 2 THE CANON OF MEDICINE 

juice to chew at, for this will be beneficial at this period and will 
prevent ulcers from forming in the gums and dull the pam [and 
irritation of teething]. The gums may also be rubbed with salt 
and honey to relieve the pain. 

When the teeth are fully out, the infant may be given a 
stick of liquorice or root of liquorice (not too dry) to bite at. 
When the canines are fully out it is good also to rub the neck 
with some form of sweet oil. Later still, when the infant begins 
to talk, its teeth should be rubbed, especially at their bases. 

3. Concerning the Diseases of Infancy 

714. The chief mode of treating infants is by controlling 
the wet-nurse. If there should be any suspicion of plethora of 
blood in her, bleeding or cupping should be done. If there be 
plethora of some other humour, that must be drained also. 
When it is necessary to bind, or to loosen the bowels, or to pre- 
vent the ascent of vapours to the head, or to rectify the respiratory 
organs, or to correct an intemperament, the method of treating 
this is by way of the food "and drink [of the nurse]. If it becomes 
necessary [for the nurse] to procure plentiful evacuation by the 
bowel, or if this occurs spontaneously ; if emesis needs to be 
procured, or if vomiting occurs spontaneously, it is best to give 
the infant to someone else to nurse during that period. 

715* DISORDERS DURING DENTITION 

Inflammation ■ of the gums (gingivitis) may occur during 
dentition. Inflammations, may also occur in the ligamentous 
structures round the mandibles, causing trismus. In such 
cases one should gently press the parts with the finger and rub 
in one of the oils named in the section dealing with the eruption 
of the teeth, or honey which has been well mixed with oil of 
chamomile, or with turpentine oil. One may also pour warm 
water, in which chamomile and dill have been boiled, over the 
top of the head from a height. (Cf. 414.) 

For burning fain in the gums apply oil and wax as an epitheme 
or use salted flesh which is a little " high." 

TAegineta advises rubbing the gums frequently with the finger alone or anointed 
with fowl-grease, while the infant is in the bath. When the teeth are just about to 
show anoint the head with sweet oil and drop some into the ears. He recommends 
the amount of food to be increased, and advocates warm baths. For itching of the 
gums, he says the flesh of an old pickle will relieve.] 

Diarrhoea. This is specially apt to arise during dentition. 
Some account for it as due to the sucking in by the infant of 



THE CANON OF MEDICINE 373 

salty sanious effete matters from its own gums along with the 
milk. ^ But it is possible that this is not true ; that the real 
cause is an interference with the natural faculty, so that digestion 
is imperfect and pain results. It is just this that hinders diges- 
tion in feebly constituted infants. 

Cf. Modern teaching : " Vomiting and diarrhoea must always be looked upon 
as due to some cause other than dentition, particularly to improper feeding — 
Elder and Fowler. lso °' 

If it is only slight, you will not be asked to treat it. If 
the parents are afraid it will become injurious, leading to wasting, 
one would treat by applying rose-seed, caraway, anise, and 
celery (parsley-) seed [sprinkled on wool : Aeg.] to the abdomen, 
or apply a plaster prepared with caraway and roses infused in 
vinegar, or with frumenty boiled in, vinegar. Should this fail, 
use a sixth part of a dram of goat-cheese in .cold water, taking 
care to prevent curdling of the milk in the infant's stomach 
by replacing the milk for that day with the soft yolk of an egg, 
or with morsels of bread boiled in water, or ground wheat boiled 
in water. [Hot desiccants may be used : Aeg.] 

Constipation during dentition. The treatment is by a sup- 
pository made with well-cooked honey, or with pennyroyal, or 
with iris-root (in the natural state or after scalding). A little 
honey may be given in the food. As much oil of turpentine 
as makes the bulk of a chick-pea may be gently rubbed over the 
abdomen ; or olive-oil ; or some ox-bile may be applied over 
the thigh or over the navel. Or maidenweed (bakhuri maryam) 
may be applied. [Or the abdomen may be anointed with mint 
pounded in honey : Aeg.] 

716. Convulsions during dentition. This is generally due 
to fermentative changes in the digestion, aided by nervousness, " 
especially if the baby is over-fat and humid in constitution. The 
treatment is to use oil of iris, lily, alkanna, or mallow. [Aetius 
advises against figs and acid foods.] 

Grave convulsions during dentition ; " tetanus." This is 
treated by water in which cucumber [or heliotrope] has been 
boiled ; or by oil of violets admixed with oil of cucumber [or 
oil of privet : i.e. calefacients : Aeg.]. 

If there is reason to suppose that the convulsions are due 
to dryness, because they develop after fevers, or after severe 
diarrhoea, and because they gradually become more pronounced, 
then the joints should receive an inunction with violet-oil (alone 
or beaten up with a little white wax), and violet-oil may be applied 
to ^the head. The same things should be employed vigorously 
if " dry " tetanus develop. 



374 THE CANON OF MEDICINE 

To the lay mind, all forms of gastro-intestinal catarrh, skin eruptions and 
nervous phenomena (particularly convulsions) are attributed to dentition. ' Beyond 
admitting that there is usually some congestion of the gums, with exaggerated 
salivation, some loss of appetite, restlessness, temporary rise of temperature, and 
general uneasiness, Elder and Fowler {loo. cit.) teach that these various phenomena 
depend chiefly on rickets, and nutritional errors. There is however something 
to be said for the lay view. 

After the teeth have appeared, Aegineta recommends the infant to be allowed 
to bite at a piece of nearly dry decorticated iris root. Butter and honey should 
also be inuncted. 

717. Incessant crying^ with loss of sleep. The mouth is 
constantly. whimpering. [The causes of persistent crying are : 
heat ; cold ; fleas ; gnats ; hunger ; thirst ; retained urine — 
for which give melon-seed and julep to both nurse and child ; 
retained faeces — for which give the nurse laxatives, herbs, olive 
oil, prunes : Haly Abbas.] For this condition it is necessary 
to make it sleep if possible, by giving poppy bark and seed, 
and oil and lettuce and apply poppy oil to the temples and vertex. 
If this does not suffice prepare the following medicament : Take 
bugle seed, juniper berry, white poppy, yellow poppy, linseed, 
celandine seed, purslane, plantain seed, lettuce seed, fennel seed, 
aniseed, caraway ; some of each is roasted little by little ; then 
all are rubbed together. Add one part of fried^ fleawort seed 
which is not powdered. Mix the whole with a like amount of 
sugar and give two " drams " as a potion. 

If it is desired to make it still stronger, one should add an 
amount of opium equal to a third part of it or less. 

718. Night-terrors. These are often due to over-repletion 
with food, which undergoes putrefactive change. The stomach 
is aware of this. An injurious effect passes on from the sensitive 
faculty to the formative and imaginative faculties, wherefore the 
terrifying visions arise. It is necessary therefore to see that the 
stomach is not full at bed-time ; honey should be given the 
infant to lick, and in this way it will digest that which is in the 
stomach and displace it. 

719. Water on the Brain. This is discussed under the 
heading of diseases of the head. 

Inflammation in the brain. Siriasis. There is pain in the 
eyes and the throat, and the face becomes yellow. [The body is 
dry ; the fontanelles are depressed, the orbits sunken : Aeg.] 
Hence the brain must be rendered cool and moist by the use of 
cortex of cucumber, parings of gourd, juice of garden nightshade, 
and especially purslane juice, and rose oil with a little vinegar, 
and rose oil with egg-yolk. Each of these is constantly changed. 

720. Affections of the mouth. Aphthous stomatitis. 
Aphthae. Thrush. — Aphthae are plentiful when the lining 



THE CANON OF MEDICINE 31$ 

membrane of the tongue and mouth is too delicate to bear 
touching, even by the wateriness of the milk, for it is this that 
is injurious to it, and gives rise to" the aphthae. The condition 
is worse, and dangerous to life, if they remain immature and 
black like charcoal. The condition is more favourable if they 
are white or yellow. The . treatment is to employ some such 
gentle medication as -is described in special treatises on the 
subject. Sometimes triturated violets are sufficient by them- 
selves ; sometimes they need mixing with roses, a little saffron 
and carob-bean. Or, again, lettuce-juice, nightshade juice, 
purslane juice [and endive-juice] may 'suffice. If treatment is 
still resisted, use bruised liquorice root. 

Galen advised cooling astringent washes if the mucous membrane is red • 
more refngerant washes if it is yellow ; detergents if it is white anT according to 
Alsaharavms, a .powder of myrtle, saffron, and sugar. The strongest dlscutifnts 
(sandarach, rose-'od) are needed, if the mucous membrane is H disc ^ients 

When aphthae are associated with boils in the gums it is 
beneficial to use myrrh, gall, frankincense bark, thoroughly 
ground up and mixed with honey. An acetous rob* of mulberries 
and a rob of unripe grapes may suffice. Sometimes it is advan- 
tageous to bathe the gums with honey-water and wine (or, syrup 
and honey) and follow this up with some of the desiccatives we 
have named. 

If a stronger (astringent) medicament is required, use the 
leaf-veins and bark of pomegranate, and pomegranate blossoms 
and sumach, six drams of each ; galls, four drams ; aniseed 
two drams. Rub them together and thoroughly powder them 
up. Then dust this upon the gums. 

721. The eye. Prominence of the eyes. Apply juice of 
boxthorn made with milk ; then bathe with water in which 
chamomile and mountain balm have been boiled. 

_ Whiteness over the pupils, due to much crying, is treated 
with nightshade juice. 

If the eyelids are affected with blepharitis, owing to constant 
crying, treat this also with nightshade juice. 

722. The ear. Watery discharge from the ears. This is 
due to an undue degree of moisture in the body, especially in 
the brain. An ointment is prepared with wool-fat, honey, wine 
and a little alum, or nitre or saffron. This is then introduced 
into the ears with a syringe. Or it may suffice to dip wool into 

Z A° U I W1 7 e ' ° r int ° wIne to whIch a littIe saffron has been 
added, and place this in the ears. 



Lit. juice made thick. 



37 6 THE CANON OF MEDICINE 

Earache. This may be due to flatulence, or to undue 
moistness. It is to be treated by juice of boxthorn, origanum, 
salt, white sugar, lentils, myrrh, colocynth seeds and cedar 
[or, savin] seeds. Any of these should be digested in oil and 
instilled drop by drop. , 

723. Disturbance of the breathing. Difficulty oj 
breathing. Anoint the roots of the ears and tongue with oil. 
It would also be very helpful to press the tongue down so as to 
cause the infant to vomit. Warm water may also be dropped 
into the mouth drop by drop, and a little linseed and honey be 

given it to suck. . . . 

Abnormal snoring. This is noticed when the infant is in 
very deep sleep. Give linseed ground up in honey, or ground 
caraway' in honey, to lick. 

Snorting, says Aegineta, is due to improper food The stom ach beco mes 
loaded with phlegh. A linseed linctus is to be gl ven, or honey. If that does not 
suffice to stop it, vomiting is induced as above nrere dine since the 

(Laryngismus stridulus may correspond to this and the preceding, since xne 
laryJSmlsTs^pt to occur during sleep, and is aggravated by prying .whereas 
stridor may disappear under both tliese conditions. The question of adenoids 
would also come to mind). 

Constant sneezing. This may be a sign of cerebral disorder. 
In such a case this must be treated, cooling the inflammation, 
by inunction with infrigidant juices and. oils. If there be no 
inflammation, some mountain balm may be insufflated into the 
nostrils. 

Loss of voice in infants is due to constipation. Give cabbage-juice by the 
mouth or rectum (Aeg.). 

724 Cough and Coryza. Some people advise for this that 
the infant's head should be laved in plenty of warm water and 
that plenty of honey should be smeared over the tongue. After 
that, the root of the tongue should be depressed to enable the 
infant to expel the abundant phlegm by vomiting, which will 
secure recovery. Small doses of the following demulcents may 
also be given daily in new milk : gum arabic, gum tragacanth, 
quince seed, liquorice juice, brown sugar. 

725. Digestive disturbance. Weakness of the stomach. 
The abdomen should be anointed with musk and rose or myrtle 
water. Give a drink containing quince juice and a little clove 
or nutmeg, or three-eighths of a dram of nutmeg with a small 
quantity of quince-juice. . 

Severe vomiting. This may be treated with three grams 
of clove. A plaster containing weak anti-emetics may be applied 

over the stomach. 

Hiccough. For this administer coco-nut with sugar. 



THE CANON OF MEDICINE 377 

726. Flatulent distension. The treatment has already been 
given in the section on diseases of the head. The following 
very useful measure may be here mentioned. Take equal parts 
of origanum,_ castoreum and caraway. Rub them up and mix 
together. Give the weight of three barley grains in a draught. 

Colic. The infant writhes and cries. Hot water appli- 
cations should be made to the abdomen, using also plenty of 
warm oil and a little wax. 

Griping. This is due to cold. Beneficial for this condition 
is the following •: three drams of each of nasturtium and caraway; 
grind them together. Pass through a sieve. Intersperse them 
with old cow butter. Give as a draught with cold water. 

727. Prolapsus ani. Give pomegranate bark, fresh myrrh, 
inner rinds of acorns (or, chestnuts), dried roses, burnt horn' 
alum of Yamen, nails of goats, pomegranate blossoms (unopened) 
and nails of fowls. Take equal parts and thoroughly boil them 
together in water until all their virtue has come out. Then give 
as an enema, tepid. 

[Aegineta advises applications of tepid brine or salt water. In modern words • 
give astringent enemata.] 

728. Hernia. When a child cries very much, a swelling 
may form in the groin or navel. This is a hernia. Some advise 
that it should be rubbed with cardamon (bishop's weed) and 
sprinkled with egg-white, a thin bandage being applied tightly 
over the place. Others advise burnt bitter lupin, as an infusion 
in wine and myrrh, placed over the part. Stronger remedies 
are : hot styptics (astringents), such as myrrh ; cypress bark ; 
cypress fruit ; aloes ; acacia fruit. [Compresses of alum, galls, 
etc. : Aetius.] See also the special chapter on the subject. 

729. Formation of an inflammatory mass between the throat 
and stomach [= retro-pharyngeal abscess?]. This sometimes 
spreads to the^ muscles and cervical vertebrae. The treatment 
is to cause the infant's bowels to act, using a suppository. After 
that, give mulberry rob and the like. 

An inflammatory mass may form in the navel, especially 
after the cord has separated. In this case one should use Celtic 
spice and_ turpentine ; dissolve them in rape-seed oil. They 
may be given internally or applied as a plaster over the navel. 

730. Worms. Round worms are very injurious when they 
arise in the small intestine. Thread-worms are usually round 
the anus. Flat worms are rare. Round worms are treated with 
absinthe water (wormwood of Pontus), of which a little is given 
m milk, according to its concentration. It may be necessary 



378 THE CANON OF MEDICINE 

to apply a plaster over the abdomen, made up of Kabul rice, 
myrobalan, ox-bile, and colocynth pulp. To treat threadworms 
take one part of each of elecampane and madder [chelidonium ; 
a kind of cucumber : (other readings)] ; add sugar equal in 
bulk to the whole. Give as a draught with hot water. 

731. Disorders of the Skin. — [Aegineta gives the follow- 
ing advice : — (i) Attend to the diet of the wet-nurse. Give sweet 
articles of food. (2) Attend to the diet of the child ;_ (a) this 
should not be too rich or too spare; {b) avoid constipation: add 
a little honey to the food; or, should this prove inadequate, add 
turpentine to the bulk of a chick-pea; (c) avoid looseness cf the 
bowels: add millet to the food.]' 

Furunculosis. Pimples forming all over the body. If they 
are ulcerating and black it is a fatal sign. If they resemble 
aphthae, it is also mortal, especially when they spread out. If 
they are white, it is more hopeful. If red, it is also more hopeful. 
If they come out freely, it is a better sign. 

The treatment in all cases consists in using fine desiccants 
dissolved in the bath-water, such remedies as rose, myrtle, 
mastic-leaves, tamarisk, and their respective oils being boiled 
in the water. [Other remedies recommended by Alsaharavius : 
lotions of marjoram, mint, centaury ; ointments of spuma 
argenti, ceruse, armenian bole, sulphur, mercury, almonds.] 

If the furuncles are healing, they should be left alone until 
they are mature ; and they are then treated. 

If they are ulcerated, they need an ointment of ceruse. They 
may need bathing with honey-water and a little nitre, as one does 

aphthae. 

If they scab over it will be necessary to use something 
stronger. One therefore bathes them with aqueous borax mixed 
with milk, to enable it to be borne. 

If they become vesicular, they should be steamed, and have 
water poured over them in which myrtle and rose and bogrush 
(schoenus), quinsywort- (asperula) and the (young) leaves of the 
mastic tree have been boiled. 

For vesicular eruptions, Rhazes advises : (i) decoction of dates and figs with 
fennel-water ; (2) when the rash is fully out, give rose-water baths, myrtle-water 
baths, and then rub the skin with oil of roses. 

Intertrigo. Apply ground myrtle as a dusting powder, or 
use powdered liquorice root [or iris root] ; or finely ground-up 
.rose or galangale, or barley flour, or lentil flour. 

Pruritus.— Foment and anoint with refined oil, in which a little wax has been 
melted (Aeg.). Correct the acrimony of the mother s milk (Alsaharavius^ Stop 
all sweets and salts in the mother's diet, because they inflame the blood. Immerse 
the child in a bath of mallows, pearl barley, fenugreek, gourds, etc. (Rhazes). 



THE CANON OF MEDICINE 379 

732. Fevers. In this case it is best to treat the nurse 
by giving her such remedies as pomegranate juice mixed with 
oxymel and honey and succus citruli, and a little camphor and 
sugar [or, acetous syrup of pomegranate and honey and cucumber 
juice, with a little camphor and sugar]. Then induce sweating 
by using fresh reeds, which are squeezed so that their juices can 
be applied to the head and feet, covering these parts therewith. 

4. The Regimen from Infancy to Adolescence 

733. The great principle here is the inculcation of control 
of the emotions. One should take care that they do not give way 
to anger and fear, or be oppressed by despondency, or suffer 
from sleeplessness. They should therefore be allowed that which 
is pleasing and appetizing and one should avoid giving them 
anything arousing disgust. 

There are two useful objects attained in this way. The first 
is that the mind grows from its very start accustomed to favour- 
able emotions, and develops a fixed habit for good. The second 
is that the body is also benefited. For just as bad habits of thought 
supervene on intemperament of the body, so also a physical 
intemperament may be traced to habits of mind which are 
contrary to the ideal. 

Anger is a strong calefacient. Despondency is a desiccant. 
Torpor relaxes (retards) the sensitive faculties, and causes the 
constitution to tend towards the phlegmatic type. Therefore 
in safeguarding the emotions the health of the mind and body 
are at the same time maintained. 

734. When the child awakes, it should first have a bath. 
He should then be allowed to play for an hour. Then he should 
have his breakfast. Then he should be left to play for a long time. 
Then he should have another bath. Then he should have a 
hearty [light : Aeg.] meal, but he must not be allowed to drink 
water with his meal, because otherwise insufficiently digested 
chyle will become absorbed and disperse